CMS backs coverage of FDG-PET for cervical cancer

The U.S. Centers for Medicare and Medicaid Services (CMS) is recommending national reimbursement coverage for FDG-PET for the initial staging of cervical cancer, concluding that the modality can make "meaningful changes in therapeutic management and improve health outcomes."

CMS proposes to cover the use of one FDG-PET exam for staging in beneficiaries who have biopsy-proven cervical cancer when the beneficiary's treating physician determines that the FDG-PET study is needed to determine the location and/or extent of the tumor for the following therapeutic purposes related to the initial treatment strategy:

  • To determine whether the beneficiary is an appropriate candidate for an invasive diagnostic or therapeutic procedure
  • To determine the optimal anatomic location for an invasive procedure
  • To determine the anatomic extent of tumor when the recommended antitumor treatment reasonably depends on the extent of the tumor

In its proposal, CMS also agreed with a petition filed to support PET for cervical cancer to exclude coverage for diagnosing cervical cancer, since the condition is diagnosed by biopsy.

"There is no credible evidence that the results of FDG-PET imaging are useful to make the initial diagnosis of cervical cancer, and therefore do not improve health outcomes, and ... CMS proposes to noncover FDG-PET for this indication," CMS wrote.

The original request for reconsideration was filed by Dr. Perry Grigsby, a professor of radiation oncology and radiology, and Dr. Barry Siegel, a professor of radiology, both of Washington University in St. Louis. Siegel also serves as co-chair of the National Oncologic PET Registry (NOPR) Working Group.

CMS expects to announce its proposed decision on November 8 and have a final ruling by February 6, 2010.

Related Reading

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CMS pitches 90% use rate in proposed 2010 MPFS rule, July 1, 2009

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

CMS to raise hospital outpatient payments 3%, July 8, 2008

CMS reconsiders cervical cancer FDG-PET coverage, May 12, 2009

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