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Prepare Your Front Lines for 2 Medicare Policy Changes

Published on Sun Sep 12, 2004

Proposals affect coding for diagnostic PET, therapeutic ultrasound

If your doctor uses PET to diagnose dementia or treats fractures with ultrasound, check out what CMS could have in store for you.
 
First, CMS is considering covering the use of FDG- PET (fluorodeoxyglucose-positron emission tomography) to set apart those with Alzheimer's from other dementia patients. CMS may also cover FDG-PET to help diagnose early dementia in those with a neurodegenerative disease.
 
According to the draft decision, CMS will cover FDG-PET only when specific requirements are satisfied, such as meeting the diagnostic criteria for both Alzheimer's and fronto-temporal dementia, being evaluated for specific alternative neurodegenerative diseases or causative factors, and having the cause of the clinical symptoms remain uncertain. See the Web site www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp?id=104 for more on this possible change and the draft decision.   
 
While not generally performed by radiology practices, a therapeutic ultrasound procedure can be used to treat the nonunion of a fracture. CMS may soon allow this service without requiring at least one surgical intervention first. According to a National Coverage Analysis tracking sheet (available on the CMS Web site www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=135), CMS is reconsidering its National Coverage Determination regarding this procedure. A medical technology company has supplied CMS with reanalyzed data on heal rates that could influence the CMS decision. Expect official word on this issue in April 2005.

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