Reston, Va.Seven medical imaging groups wrote a joint letter to the Centers for Medicare and Medicaid Services (CMS) to formally request coverage of two fluorodeoxyglucose (FDG) positron emission tomography (PET) scans for a patient during the initial treatment evaluation. Currently, CMS covers only one FDG-PET study during initial treatmenta limitation that the groups believe is contrary to good clinical practice under certain circumstances.
"It is absolutely critical for CMS to reconsider this decision," said Michael M. Graham, Ph.D., M.D., president of SNM and director of nuclear medicine at the University of Iowa Carver College of Medicine in Iowa City. "It is unacceptable to have reimbursement for only one scan when you need two in order to assess efficacy of treatment."
The letterwhich was signed by the leadership of the National Oncologic PET Registry (NOPR) 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 SNMpresents CMS with three practical scenarios in which a second initial FDG-PET scan would be necessary for optimal patient care. The first example is when PET is used for the diagnosis or staging of a tumor and the course of treatment is determined to be radiation therapy. In certain circumstances, a second PET scan may be needed for successful radiation therapy planning.
Second, in the event that PET used to evaluate a suspicious lesion came back with false-negative results and the patient is later diagnosed with cancer, a second PET scan is needed for initial staging before treatment. Finally, the third scenario applies to patients with newly diagnosed cancer who had to delay their treatment either because of reluctance on their own part or because of another medical illness that needed to be addressed first. It may be medically necessary for that patient to
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Society of Nuclear Medicine