PET reimbursement depends on clinical trials and data registry

February 3, 2005

The Centers for Medicare and Medicaid Services has announced a new initiative to provide reimbursement for PET when patients and physicians participate in high-quality clinical studies or submit information to a PET data registry. The announcement heralds a move away from PET coverage decisions on an indication by indication basis.

The Centers for Medicare and Medicaid Services has announced a new initiative to provide reimbursement for PET when patients and physicians participate in high-quality clinical studies or submit information to a PET data registry. The announcement heralds a move away from PET coverage decisions on an indication by indication basis.

The move would allow coverage for PET use in previously uncovered applications such as the evaluation of patients with cervical, brain, pancreatic, ovarian, and testicular cancers.

"This is a very innovative decision on the part of CMS. In essence, they would be providing provisional coverage for PET in a variety of applications, with permanent coverage pending results of clinical trials and evaluation of the data registry," said Dr. Bruce Hillman, chair of the American College of Radiology Imaging Network.

One of the more important aspects of this move is the decision to tie reimbursement to a national data registry, according to Hillman. The registry will be managed by ACRIN and the Academy of Molecular Imaging. Participating referring physicians would submit surveys electronically to the ACRIN archives both before and after PET scans, providing a national database for PET applications.

Reimbursing PET outside of clinical trials would depend on the amount of data and research that radiologists and other interested physicians provide for the data registry, he said. The more radiologists and physicians participate in the program and the more data are submitted to the registry, the faster an indication could be approved for reimbursement.

National PET data collection would allow ACRIN and AMI researchers to evaluate the effectiveness of PET for a variety of indications and to determine whether the modality had any effect on a referring physician's clinical decisions.

Determination of just how the registry will work and will be set up is under way, Hillman said. Medicare coverage for new indications will go into effect when the final registry is implemented later this spring.

"One of the major outcomes of CMS's decision is that patients will now have access to PET who would not have had access under the previous method of reimbursement," he said.

For more information from the online Diagnostic Imaging archives:

Medicare begins PET Alzheimer's reimbursement

Rx for PET referral shortage

PET/CT profitability hinges on building the market

PET reimbursement awaits pivotal year in Washington

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