Proposed Decision Memo for FDG PET for Solid Tumors
On January 5 2009, CMS posted a proposal for public comment that expands the coverage of several PET indications. This is largely based on the impressive change-in-management results from the National Oncologic PET Registry (NOPR). Currently, imaging centers and hospitals that are registered to participate in the NOPR are getting reimbursed for several PET indications that are not officially covered by Medicare.
This new CMS coverage document proposes that indications currently covered with evidence development (CED) through the NOPR be officially covered by Medicare for "initial treatment strategy" (formerly "diagnosis" and "staging"), with some exceptions such as prostate cancer. These same indications will only be covered for "subsequent treatment strategy" scans (formerly "restaging" and "monitoring") through the continued CED. The currently approved indications remain covered; however, CMS proposes to change the existing language of diagnosis,staging, restaging and monitoring of therapy to initial treatment strategy and subsequent treatment strategy as well.
CMS is looking for data-driven answers to some very specific questions in the submitted comments, please see the proposed decision memo to review their questions. For a detailed comparison of the current and the proposed PET coverage framework, click on FULL STORY below.
View both the proposed decision memo and submit comments on the CMS website
Read more details in the Society of Nuclear Medicine press release
Read industry opinions in the Diagnostic Imaging on-line article