The Medical Imaging and Technology Association plans to make formal recommendations to the Centers for Medicare and Medicaid Services to reconsider its exclusionary coverage of PET and PET/CT.
Despite the success of PET and PET/CT in diagnosing and monitoring a wide range of cancers, Medicare still only pays for the imaging procedure for limited indications.
Unlike MRI and standard CT reimbursement that's determined by local coverage determinations, PET falls under Medicare's noncoverage determination, which limits its use.
Last year, MITA convened a workshop with radiology organizations and other medical societies along with representatives with CMS to discuss alternative pathways to getting PET greater coverage under Medicare, based on an article in the February issue of the Journal of the American College of Radiology.
The group identified five proposals that will soon be narrowed down to formal recommendations to CMS. They called for making the noncoverage determination process more nimble, for the Food and Drug Administration to conduct a parallel review along with CMS or for CMS to grant immediate coverage that's subject to further review.
In 2006, CMS created the National Oncologic PET Registry, which led to several new indications covered by Medicare. But ultimately that process was criticized for being too burdensome, according to the article.