CMS to Cover Three Oncology FDG-PET Scans

June 12, 2013

CMS has agreed to cover three oncology FDG-PET scans, a revision from the proposed single-scan coverage, and one PET advocates lauded.

CMS has agreed to cover three oncology FDG-PET scans, a revision from the proposed single-scan coverage, and one PET advocates lauded.

In a decision memo released this week, CMS said it was ending the requirement for coverage with evidence development for oncologic FDG-PET. This removes the requirement for prospective data collection by the National Oncologic PET Registry (NOPR) for covered cancer types. Coverage of additional scans beyond the three after initial anti-tumor therapy will be determined by local Medicare Administrative Contractors. 

The Society of Nuclear Medicine and Molecular Imaging said the decision “will have a significant impact on patient care.”

“We appreciate the fact that CMS has changed the limit from one scan to three,” SNMMI 2013-2014 vice president-elect, Hossein Jadvar, MD, PhD, MPH, MBA, FACNM, said in a statement. “However, it will be important for the local contractors to allow more than three when clinically necessary.”

SNMMI also noted CMS’s ruling that the use of FDG PET/CT to guide prostate cancer treatment was reasonable and necessary.

The Medical Imaging and Technology Alliance (MITA) also commended the decision, saying the group has long supported coverage decisions that facilitiate access to PET imaging. “This final decision on FDG-PET for solid tumors is a step in the right direction in ensuring access to critical imaging procedures for patients with cancer,” MITA’s executive director Gail Rodriquez said in a statement.