News | January 12, 2009

SNM Praises CMS for Expanding PET Reimbursement

January 12, 2009 - The Centers for Medicare and Medicaid Services (CMS) released a draft of their proposed positron emission tomography (PET) national coverage determination (NCD) to allow for reimbursement of PET by the federal government for patients with all types of cancer.

The proposed decision expands coverage to include cancer staging and restaging, in addition to initial diagnosis. Two important items in the CMS draft include a proposal to replace coverage for “diagnosis, staging and restaging and treatment” with “initial treatment” and “subsequent treatment.” A public comment period on these and other items will continue through February 5. A final decision is expected in April 2009.

In concert with other nonprofit medical associations, SNM has worked closely with CMS over the past three years to increase access to these medically essential molecular imaging procedures used for the diagnosis, staging and restaging of cancer. Molecular imaging provides a rich portrait of exactly what is going on in a patient’s body, offering a wealth of useful information to help shape a treatment plan.

"We are highly encouraged by the CMS proposal to broaden reimbursement for PET for Medicare beneficiaries who are being treated for cancer," said SNM President Robert W. Atcher, Ph.D., M.B.A. "Because PET is a minimally invasive imaging procedure that gives physicians critical information for patient care, expanded use of the technique in cancer diagnosis and treatment will help tailor the patient's treatment to their current stage of the disease."

In 2006, a nationwide study—the National Oncologic PET Registry (NOPR)—was established to collect data in response to a proposal from CMS to expand coverage for PET to include cancers and indications not presently eligible for Medicare reimbursement. Overwhelmingly, the data collected showed that PET has significant advantages for diagnosing, staging and restaging many types of cancer. According to a study published last year in The Journal of Clinical Oncology, PET resulted in a change in management of treatment in more than one-third of cancer patients, regardless of the type of cancer.

"This is a critical step in gaining access to critical molecular imaging and nuclear medicine tests for people nationwide with all forms of cancer," added Atcher.

For more information: www.snm.org

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