Comment on CMS PET Scan Expansion

On Jan. 6 the Centers for Medicare & Medicaid Services (CMS) proposed a national coverage determination (NCD) broadening initial diagnostic testing with positron emission tomography (PET) scans for many Medicare beneficiaries’ cancer treatment.

PET is a diagnostic imaging procedure using a radioactive tracer to evaluate glucose metabolism in normal tissue and tumors, providing clinical information that can guide the tumor treatment and help distinguish benign from cancerous lesions.

CMS issued an NCD in 2005 tying Medicare PET scan coverage to the clinical information collection’s effects on beneficiaries’ cancer care. The information was collected through the National Oncologic PET Registry (NOPR) observational study under the Coverage with Evidence Development (CED) program. Because of this data collection process, these tests are now covered by Medicare for initial cancer treatment. This was the first time CMS reviewed medical evidence based on the CED program.

To date, CMS said, there isn’t enough evidence to consider PET scans for guiding subsequent treatments medically necessary.

You can post comments on the proposed decision to expand initial diagnostic testing with PET for cancer treatment through Feb. 5. CMS intends to issue the final NCD in April.

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One Response to “Comment on CMS PET Scan Expansion”

  1. Lavanya Mohan says:

    Restaging is rare and needs to be checked on the medical necessity before reimbursement.
    Whereas, diagnosis is requiring more need with PET scans, particularly for Hodgkin’s lymphoma, early detection is proved to be difficult without such medical initiatives, as otherwise may get more severe.
    Kindly consider.
    Thank You,
    Regards,
    Lavanya Mohan
    01/25/09

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