The Centers for Medicare and Medicaid Services (CMS) believes one PET scan is enough when doing a patient’s initial treatment evaluation, but seven medical imaging groups disagree.
PET advocates press second scan coverage
The Centers for Medicare and Medicaid Services (CMS) believes one PET scan is enough when doing a patient’s initial treatment evaluation, but seven medical imaging groups disagree. The groups this week signed a joint letter to CMS formally requesting coverage of two fluorodeoxyglucose (FDG) scans per patient under certain circumstances. They argued that limiting coverage to just one may be contrary to good clinical practice. Three examples underscoring the need for a second initial FDG/PET scan were highlighted in the letter, signed by the leadership of the National Oncologic PET Registry Working Group, the Academy of Molecular Imaging, the American College of Nuclear Medicine, the American College of Radiology, the American Society for Radiation Oncology, the Institute for Molecular Technologies and SNM. The first addresses the use of PET for the diagnosis or staging of a tumor when the course of treatment is determined to be radiation therapy and another PET scan is needed for successful radiation therapy planning. The second is when PET returns a false-negative when evaluating a suspicious lesion for a patient later diagnosed with cancer and another scan is needed for staging before treatment. The third applies to patients with newly diagnosed cancer who had to delay treatment and another scan is required to evaluate the disease after a prolonged period of time.