Reston, Va.SNM applauds today's decision by the Centers for Medicare and Medicaid Services (CMS) to expand coverage of positron emission tomography (PET) scans in the initial treatment strategy of patients with cancer. This decision was based, in large part, on compelling clinical evidence of the effectiveness of PET for cancer management and treatment contained in a comprehensive study known as the National Oncologic PET Registry (NOPR).
"This is a major victory for patients," said Robert W. Atcher, Ph.D., M.B.A., president of SNM and University of New Mexico/Los Alamos National Laboratory professor of pharmacy. "CMS' decision to cover PET scans for cancer demonstrates the intrinsic medical value of PET and important role of these scans in diagnosing, staging, restaging and monitoring treatment for many cancers."
Previously, PET scans for many cancers would be reimbursed only if the PET facility submitted data to the NOPR. Now, all Medicare beneficiaries with certain cancers will be able to receive Medicare coverage for at least one PET scan, as prescribed by their physicians. The nine currently covered cancers breast, cervix, colorectal, esophageal, head and neck, lymphoma, melanoma, non-small cell lung and thyroidhave all been expanded to cover the subsequent treatment strategy, in addition to initial diagnosis. Additionally, Medicare is now expanding coverage to include ovarian cancer and myeloma, making a total of eleven indications now covered for both the initial diagnosis and subsequent treatment strategy for patients. For all other cancers, PET coverage for subsequent treatment strategy evaluation requires participation in an approved Coverage with Evidence Development (CED) program, such as a modified NOPR.
The new CMS decision will save patients thousands of dollars who would otherwise have to pay out-of-pocket for their PET scans. Additionally, this decision increases the likelihood that private insurers will eventually
|Contact: Amy Shaw|
Society of Nuclear Medicine