News | July 08, 2013

SNMMI Responds to CMS PET Coverage Decision

SNMMI disappointed in the draft Medicare decision from CMS

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is disappointed in the draft Medicare decision from the Centers for Medicare & Medicaid Services (CMS) proposing Coverage with Evidence Development for the use of beta-amyloid positron emission tomography (PET) imaging agents. SNMMI believes that sufficient evidence exists to support immediate coverage, which would change patient management, leading to better health outcomes for patients and assisting families making care decisions.

CMS agreed to cover one PET scan to exclude Alzheimer's disease, but only for patients participating in specific clinical studies under a coverage with evidence development (CED) program, which grants conditional reimbursement upon collection of specific data.

Appropriate use criteria (AUC) jointly developed by the Alzheimer’s Association and SNMMI demonstrate that more than adequate evidence exists for Medicare to cover without additional onerous steps.  Coverage with evidence development is not appropriate for this test, which the U.S. Food and Drug Administration has already approved, noting its clinical utility. The AUC clearly highlight indications for which immediate coverage is warranted.

SNMMI will soon be releasing a comprehensive education program for physicians who will be referring patients and those who will be reading the scans. Additionally, SNMMI is developing technical procedure guidelines for ensuring quality in the performance of the procedures.

For more information: www.snmmi.org

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