CMS scrubs rule restricting PET tracer coverage

2020 07 01 22 14 2802 Washington Dc Capitol 400

The U.S. Centers for Medicare and Medicaid Services (CMS) has officially retired national noncoverage language from the books for PET imaging using radiopharmaceuticals for nononcologic indications.

CMS updated section 220.6 of the Medicare national coverage determinations (NCD) manual to allow Medicare to cover nononcologic agents at the discretion of Medicare administrative contractors (MACs). The new policy goes into effect on January 1, 2022, and aligns coverage of nononcologic imaging agents with oncologic radiotracers, which have been covered by Medicare contractors since 2013.

The move was applauded by groups that have been working with CMS for more than a decade on the issue, including the Medical Imaging & Technology Alliance (MITA).

"This jurisdictional change by CMS will improve beneficiary access to PET imaging for cardiac, neurologic, and other conditions while reducing CMS administrative burdens and allowing for innovative diagnostic tools still in development to get to patients more quickly," said Sue Bunning, MITA industry director of molecular imaging and PET, in a news release.

MITA noted that this policy will not apply to beta-amyloid imaging tracers, which remain covered under a separate NCD (220.6.20 Beta Amyloid Positron Tomography in Dementia and Neurodegenerative Disease). In September, CMS announced a formal reconsideration of how it covers beta-amyloid PET scans.

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