CMS expands cervical cancer coverage

Nov 10, 2009

The U.S. Centers for Medicare and Medicaid Services (CMS) has given final approval for coverage of one FDG-PET exam for the initial staging of patients with biopsy-proven cervical cancer.

CMS concluded that FDG-PET as a diagnostic test "affects health outcomes through changes in disease management brought about by physician actions taken in response to test results. Such actions may include decisions to treat or withhold treatment, to choose one treatment modality over another, or to choose a different dose or duration of the same treatment."

FDG-PET would be used to determine:

Whether a patient is an appropriate candidate for an invasive diagnostic or therapeutic procedure
The optimal anatomic location for an invasive procedure
The anatomic extent of a tumor when the recommended antitumor treatment reasonably depends on the extent of the tumor

The November 11 ruling follows CMS' recommendation in August for expanded coverage for cervical cancer.

The final decision is based, in part, on data supplied by the National Oncologic PET Registry (NOPR), based on 984 cervical cancer scans, which included both initial and subsequent treatment planning. Of those 984 exams, 341 scans were performed during initial assessment of patients with cervical cancer. Among the 341 scans, changes in treatment plans were noted in 36.1% of the cases.

SNM president Dr. Michael Graham, Ph.D., director of nuclear medicine at the University of Iowa in Iowa City, said the CMS decision is "an important step forward. We recognize that FDG-PET is a powerful tool for staging many malignancies and helping guide decisions about how to best treat each patient. The most recent decision from CMS will be especially helpful for gynecologists to effectively diagnose and treat cervical malignancies."

CMS cuts SPECT MPI payments 36%, sets CCTA rates, November 5, 2009

Societies rally to repeal Medicare SGR formula, October 21, 2009

CMS backs coverage of FDG-PET for cervical cancer, August 14, 2009

CMS proposes 1.9% increase in hospital outpatient payments, July 8, 2009

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