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HCFA may move on FDG Medicare payments

HCFA may move on FDG Medicare payments

There may be light at the end of the tunnel regarding Medicare payments for studies with the PET radioisotope fluorodeoxyglucose (FDG). The Health Care Financing Administration last month informed members of the Institute for Clinical PET that the agency is preparing to make a positive recommendation covering Medicare reimbursement for the use of FDG in lung cancer studies.

HCFA's move would be the first time that the agency has allowed Medicare payment for FDG studies, and it could help spark the still-developing market for clinical PET. It is also expected to increase demand for high-energy imaging on conventional gamma cameras, such as with coincidence detection techniques.

Sources close to the ICP indicate that HCFA has agreed to forward its recommendation in the next 60 to 90 days to intermediary insurance companies that actually make payments to Medicare beneficiaries. The level of reimbursement and whether it will be set at different levels for conventional PET and coincidence detection exams are still unknown.

In another bit of good news for PET advocates, legislation that would strip the Food and Drug Administration of its power to regulate cyclotron-produced radioisotopes passed the Senate in September and appeared headed for victory in the House of Representatives as well. The bill is part of legislation to reform the FDA, and it would mandate that cyclotron-produced radioisotopes be regulated under state practice of pharmacy rules.


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