CMS Reopens NCD for PET Coverage

A request from the Medical Imaging & Technology Alliance (MITA) and other stakeholders has the Centers for Medicare & Medicaid Services (CMS) reconsidering coverage of certain uses of positron emission tomography (PET).

Section 220.6 of the National Coverage Determination Manual identifies fluorodeoxyglucose F-18, rubidium Rb-82, ammonia N-13, and sodium fluoride F-18 as the only nationally covered radioisotopes for certain defined uses in PET. Certain other uses of PET with these radioisotopes are covered only when furnished in clinical studies under Coverage with Evidence Development (CED) or are specifically nationally noncovered. All remaining uses of PET are nationally noncovered.

MITA would like coverage of these remaining uses of PET to be determined locally by Medicare administrative contractors (MACs) when PET is furnished with new FDA-approved radioisotopes, including those that may be approved by FDA in the future.

“We believe there is now consensus that the recent advances in imaging and CMS’ past experience with PET coverage no longer support a clinical rationale for a pre-emptive national non-coverage policy for new PET radiopharmaceutical agents that undergo rigorous FDA review and approval,” MITA says in a letter to CMS.

PET is a minimally-invasive diagnostic imaging procedure used to evaluate normal and diseased tissues. Injected radioactive tracers give off subatomic particles, known as positrons, as they decay. PET uses a positron camera (tomograph) to measure the decay of these radioisotopes. The rate of tracer decay provides biochemical information on the tissue being studied.

CMS is soliciting public comment relevant to MITA’s request until Aug. 10.

Source: Medicare Coverage Database

2017-code-book-bundles-728x90-01

Latest posts by admin aapc (see all)

One Response to “CMS Reopens NCD for PET Coverage”

  1. Paulo says:

    Isn’t that called “White Coat Syndrome?”My moethr made my father tag along two years ago when I went to a urologist about serious pain in the lower abdomen and blood in the urine. She was not concerned about my reaction – she figured, possibly with justification, that it would be the same whether I was fine or terminal. She wanted to make sure she got the information straight, and not “Oh, it’s fine. Nothing to worry about. I have surgery next week.” In fact, it was fine, nothing to worry about, and I did have surgery the next week. And the next month – for a total of four procedures. But still, nothing to worry about and it’s fine now, so there you are.At least she knew better than to insist on coming herself – some moethrs might not understand that given the choice between visiting a urologist with their mom, and not going at all, many men would choose the latter even if it meant a lingering painful death.Sometimes it’s difficult to realize that what a professional is telling you is prescisely what he’s saying. There are not always code phrases going over your head, but given some MDs’ poor people skills it’s no wonder many patients don’t quite trust them.

Leave a Reply

Your email address will not be published. Required fields are marked *