CMS Rules to Broaden PET Procedure Coverage

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The Centers for Medicare & Medicaid Services (CMS) is ending the requirement for coverage with evidence development (CED) under §1862(a)(1)(E) of the Social Security Act for 18F fluorodeoxyglucose (FDG) PET for cancer patients, which means that physicians who provide FDG PET must no longer take part in the National Oncologic PET Registry (NOPR) for the scans to be covered.

In addition, CMS will include coverage for FDG PET/CT to guide subsequent anti-tumor treatment strategy for patients with prostate cancer, and patients may have up to three covered FDG PET/CT scans after their initial cancer treatment. After that, coverage for additional scans will be up to the local Medicare administrative contractor.

However, CMS will continue CED for NaF PET through the existing NOPR.

The ACR says CMS incorporated many of the College’s recommendations from last April. ( Click here for the full joint letter the ACR submitted).
Also signing that letter was the Society of Nuclear Medicine and Molecular Imaging (SNMMI). The Society applauded the ruling and said it would will continue working to develop evidence for NaF PET through the NOPR program.

“We appreciate the fact that CMS has changed the limit from one scan to three,” added SNMMI 2013-2014 vice president-elect, Hossein Jadvar, MD, PhD, MPH, MBA, FACNM, in a statement. “However, it will be important for the local contractors to allow more than three when clinically necessary.”

Read the CMS decision memo.