CMS ends noncoverage of PET infection and inflammation

2018 05 22 18 57 9927 Snmmi Logo 400

The U.S. Centers for Medicare and Medicaid Services (CMS) has ended its longstanding national noncoverage policy for PET imaging for infection and inflammation, according to the Society of Nuclear Medicine and Molecular Imaging (SNMMI).

The policy, which had been in place since a national coverage determination (NCD) by CMS in 2008, was retired in December 2020 and officially took effect on January 1. The NCD was removed after leadership, staff, and consultants from the SNMMI met multiple times with the CMS Coverage and Analysis Group from 2018-2020, according to the society.

As a result of the change, coverage determinations for PET for infection and inflammation are now made at the discretion of local Medicare Administrative Contractors (MACs). The SNMMI, the American Society of Nuclear Cardiology, the American College of Nuclear Medicine, and the American College of Radiology are now meeting with local MACs to educate and inform them of the new policy and ensure local coverage, according to the SNMMI.

In addition, the SNMMI said it will soon approve appropriate use criteria for the use of PET for infection and inflammation. A new workgroup has also been formed to create appropriate use criteria for PET in diagnosing fever of unknown origin, the society said.

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