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CMS Amends NCD for FDG PET

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  • October 1, 2010
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The Centers for Medicare & Medicaid Services (CMS) announced Sept. 24 that it is amending the National Coverage Determination (NCD) for Positron Emission Tomography (PET) for Oncologic Conditions. The government agency issued a decision memo effective Aug. 4 that retracts its restriction of one initial PET scan for therapeutic purposes related to the initial treatment strategy of solid tumors and myeloma.

CMS states in Transmittal 124, Change Request (CR) 7148, that the previous absolute restriction of one initial PET scan for beneficiaries who have solid tumors that are biopsy proven, or strongly suspected, based on other diagnostic testing is not supported by the available evidence. CMS is, therefore, amending section 220.6.17 of the NCD Manual as follows:
Medicare will continue to nationally cover one fluorodeoxyglucose (FDG) PET scan to determine:

  • whether or not the beneficiary is an appropriate candidate for an invasive diagnostic or therapeutic procedure;
  • the optimal anatomic location for an invasive procedure; or
  • the anatomic extent of tumor when the recommended anti-tumor treatment reasonably depends on the extent of the tumor.

Local Medicare contractors will have the discretion to cover (or not cover) within their jurisdictions any additional FDG PET scans for therapeutic purposes related to initial treatment strategy.
Read MLN Matters article MM7148 for further guidance.

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