The U.S. Centers for Medicare and Medicaid Services (CMS) has changed its reimbursement policy, which previously called for payment for only one PET scan for treatment planning in patients with solid tumors and myeloma.
In a decision memo posted August 4, CMS said that it received a request in April 2009 to reconsider its national coverage determination (NCD) regarding the use of PET for planning treatment of patients with solid tumors and myeloma. The NCD stipulated that CMS would pay for only one FDG-PET scan for determining tumor location or planning therapy.
However, CMS said that it now believes that the policy is not supported by the available evidence, and it is changing the NCD to remove the absolute restriction on only one scan. CMS will nationally cover for one scan, and the agency will give local Medicare administrators the say in whether additional scans should be covered. The decision memo is available by clicking here.
In its decision, CMS wrote: "For any individual beneficiary the usefulness of any additional FDG-PET scan for initial treatment planning might be affected by the beneficiary's specific medical problem, the availability of results of other diagnostic tests, and the expertise of the interpreting physician. We believe in such situations that our local administrative contractors, who may more readily obtain this information, can make these determinations about any additional FDG-PET scan for initial treatment planning within their jurisdictions."
Related Reading
CMS to correct PET overpayments, July 5, 2010
CMS proposes 6.1% cut in 2011 Medicare payments, June 29, 2010
CMS proposes change to PET restriction, May 7, 2010
CMS proposes 2011 inpatient payment rates, April 20, 2010
CMS offers reprieve to SGR rate cuts, March 31, 2010
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