CMS dropping coverage restrictions around PET imaging outside of oncology care
The Centers for Medicare & Medicaid Services is dropping certain coverage restrictions around PET imaging outside of oncology, a move providers are calling “significant” for the field.
The noncoverage determination dates to 2000, when CMS enacted broad, national restrictions for using positron emission tomography scans outside of cancer care. This forced providers to seek coverage determinations for each individual indication beyond oncology.
Under the recently released 2022 Medicare Physician Fee Schedule, however, CMS is proposing to lift this “outdated” restriction. This would leave coverage decisions tied to non-oncologic PET scans up to each Medicare Administrative Contractor.
“We believe that extending local contractor discretion for non-oncologic indications of PET provides an immediate avenue to potential coverage in appropriate candidates and provides a framework that better serves the needs of the Medicare program and its beneficiaries,” CMS said in the proposed fee schedule, released July 13.
The Society of Nuclear Medicine & Molecular Imaging on Monday called the news “significant” for the profession.
“We applaud CMS’s coverage decision, which results from years of work by SNMMI and our industry partners,” the Reston, Virginia-based group said in a July 19 update.
Meanwhile, the nuclear society joined others such as the Medical Group Management Association in expressing “dismay” at proposed cuts to physician pay in 2022. It’s pleased, however, that the feds plan to delay the penalty phase of the Appropriate Use Criteria program by one year, until Jan. 1, 2023.
“This is great news for referring physicians who needed the extra time to implement because of COVID-19,” SNMMI said.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.