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