News | January 07, 2009

CMS to Expand Coverage for PET

January 7, 2009 - The Centers for Medicare & Medicaid Services (CMS) proposed a national coverage determination (NCD) to expand coverage for initial diagnostic testing with positron emission tomography (PET) for many Medicare beneficiaries who are being treated for cancer.

Under Coverage with Evidence Development (CED) program, CMS had issued a national coverage determination in 2005 that tied Medicare coverage of PET scans to the collection of clinical information about the effect of the test on the beneficiary's cancer care. This information was obtained through the National Oncologic PET Registry (NOPR) observational study. Without CED, these tests would not have been covered by Medicare.

The purpose of CED is to develop evidence on the utilization and impact of the item or service evaluated in an NCD, so that Medicare can a) document the appropriateness of use of that item or service in Medicare beneficiaries under current coverage; b) consider future changes in coverage for the item or service; c) generate clinical information that will improve the evidence base on which providers base their recommendations to Medicare beneficiaries regarding the item or service.

The sponsors of NOPR submitted a formal written request to reconsider the 2005 coverage determination to CMS, based on the evidence they had collected and published. Medicare uses a formal evidence based process when it reconsiders past NCDs. This proposed expansion in coverage is the first time that CMS has reviewed medical evidence arising from its CED program.

"We are pleased with these first results of the Coverage with Evidence Development program and look forward to patients gaining greater access to new technologies while enhancing the evidence physicians use to make treatment recommendations," said CMS Acting Administrator Kerry Weems.

This proposed decision would remove a significant part of the CED requirement for PET scans in cancer and allow coverage for one PET scan to guide the initial treatment strategy. CED will still be required for PET scans for subsequent treatment strategies, as CMS believes that the current evidence is not adequate to provide coverage for PET scans in guiding subsequent treatment.

CMS proposes some cancer-specific exceptions to these broad requirements, which are listed in the proposed decision memorandum.

CMS will accept public comments on the entire proposed decision through February 5, 2009 and will issue a final national coverage determination in April 2009. CMS invites public comments on its proposed decision at www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=218.

For more information: www.cms.hhs.gov

Related Content

Colored areas of the brain represent regions where the loss of brain synapses in people with early-stage Alzheimer’s was greater than people with normal cognitive function.

Colored areas of the brain represent regions where the loss of brain synapses in people with early-stage Alzheimer’s was greater than people with normal cognitive function. Image courtesy of YaleNews.

News | PET Imaging | May 14, 2020
May 14, 2020 — New imaging technology allows scientists to see the widespread loss of brain synapses in early stages
 Siemens Healthineers has received clearance from the Food and Drug Administration (FDA) for its AIDAN artificial intelligence technologies on the Biograph family of positron emission tomography/computed tomography (PET/CT) systems

 Siemens Healthineers received clearance from the FDA for its AIDAN artificial intelligence technologies on the Biograph family of positron emission tomography/computed tomography (PET/CT) systems.

News | Artificial Intelligence | April 22, 2020
April 22, 2020 — Siemens Healthineers has received
Maximum-intensity PET projections at each time point for one rhesus monkey in the 89Zr-DFO-squaramide-anti-gD group.

Maximum-intensity PET projections at each time point for one rhesus monkey in the 89Zr-DFO-squaramide-anti-gD group. Image courtesy of Eric Berg, University of California, Davis, CA

News | PET Imaging | April 10, 2020
April 10, 2020 — Combining 89Zr-labeled antibodies with total-body...
Recommended best practices for nuclear imaging departments under the COVIF-19 pandemic have been issues by the ASNC and SNMMI. #COVID19 #ASNC #SNMMI #Coronavirus #SARScov2
News | Coronavirus (COVID-19) | April 03, 2020
April 3, 2020 — A new guidance document on best practices to maintain safety and minimize contamination in nuclear im
Novel scanners may open door for prognostic assessment in patients receiving cochlear implants

Iva Speck, MD, explains research showing that novel, fully digital, high-resolution positron emission tomography/computed tomography imaging of small brain stem nuclei can provide clinicians with valuable information concerning the auditory pathway in patients with hearing impairment. The research is featured in The Journal of Nuclear Medicine (read more at http://jnm.snmjournals.org/content/current). Video courtesy of Iva Speck, University Hospital Freiburg, Germany.

News | PET-CT | March 26, 2020
March 26, 2020 — Novel, fully digital, high-resolution...
A University of Colorado Cancer Center study published in the Journal of the National Cancer Institute shows an important predictor of PET-CT use

Rustain Morgan, M.D., and colleagues show racial/ethnic disparities in use of important imaging during lung cancer diagnosis. Photo courtesy of University of Colorado Cancer Center

News | PET-CT | March 12, 2020
March 12, 2020 — The use of PET-CT
MR Solutions’ dry magnet MRI system for molecular imaging on display at EMIM 2020
News | Magnetic Resonance Imaging (MRI) | February 28, 2020
February 28, 2020 — MR Solutions will be displaying its la