CMS reconsiders PET coverage framework

The U.S. Centers for Medicare and Medicaid Services (CMS) has been asked to consider replacing its current framework for determining reimbursement coverage of PET and is soliciting comments on the proposed change.

CMS currently uses a cancer-by-cancer methodology to review whether to expand coverage of FDG-PET in solid tumors. Though the current framework "has been useful," the CMS stated in a September 16 notice, "we are open to public input that [the framework] be retired and that a general policy could be developed and applied to oncologic FDG-PET imaging."

In agreeing to consider the request, CMS is broadening its review by soliciting additional public comment on the use of FDG-PET imaging for other solid tumors, as well as feedback for possible alternatives to the current coverage framework.

The new review will come under the heading of "NCA Tracking Sheet for Positron Emission Tomography (FDG) for Solid Tumors (CAG-000181R)." The 30-day public comment ends on October 17.

Currently, the National Coverage Determination Manual addresses cancers such as lung, esophageal, colorectal, lymphoma, melanoma, head and neck, breast, thyroid, soft-tissue sarcoma, brain, cervical, ovarian, pancreatic, small cell lung, and testicular.

The CMS's consideration of possible changes to FDG-PET coverage began last April, when representatives from the National Oncologic PET Registry (NOPR) formally asked the agency to expand federal reimbursement for the use of FDG-PET in oncology applications.

The NOPR request asked CMS to expand FDG-PET coverage for the diagnosis, staging, and restaging of all oncology applications not currently covered by Medicare and Medicaid.

Related Reading

CMS sets date for PET coverage meeting, August 5, 2008

NOPR asks CMS to expand FDG-PET coverage, April 11, 2008

NOPR study: PET influences cancer care, March 25, 2008

NOPR releases preliminary results of PET treatment strategies, January 11, 2008

PET changes oncology management, study shows, July 19, 2007

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