Payer Updates:
CMS Proposes to Stop Coverage on Some PET Scans
Published on Sat Nov 21, 2009
Silver lining: There will be exceptions to the no-coverage rule. On November 30, CMS released a memo proposing to stop paying for positron emission tomography (PET) scans used to diagnose cancer in the bones. The memo states that using the scans for diagnostic tests is not reasonable or necessary. CMS cites insufficient evidence supporting the idea that using PET imaging to diagnose bone metastases actually improves the health outcome of cancer patients. CMS goes further, however, to explain that PET scans will still be covered under a number of different circumstances, including "to identify bone metastasis of cancer, to inform the initial antitumor treatment strategy, or to guide subsequent antitumor treatment strategy after the completion of initial treatment." Bonus: The memo also lists a number of conditions for which CMS will allow PET imaging during approved clinical trials. Have your say: CMS has opened a public comment period on this [...]
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