CMS halts coverage with evidence development for PET

The Centers for Medicare & Medicaid Services on June 11 issued a ruling to end the requirement for coverage with evidence development for scans using 18F-FDG PET under the National Oncologic Pet Registry (NOPR) for 18-F FDG PET exams.

The change is effective immediately. Physicians will no longer have to use the NOPR for these exams. However, they are required to use the NOPR for NaF PET studies.

The Society for Nuclear Medicine and Molecular Imaging (SNMMI) applauded the move. “Since 2009, NOPR has provided the government with a great deal of evidence to prove the effectiveness of the 18F-FDG PET in oncology,” said SNMMI 2013-14 president, Gary Dillehay, MD, in a release. “We are pleased with this decision and will continue working to develop evidence for NaF PET through the NOPR program.”

The CMS ruling also upped the limits on scan coverage for subsequent patient management from one PET study to three. Coverage will be based on the decision of local Medicare contractors.

“We appreciate the fact that CMS has changed the limit from one scan to three,” said SNMMI 2013-14 vice president-elect, Hossein Jadvar, MD, PhD, MPH, MBA. “However, it will be important for the local contractors to allow more than three when clinically necessary.”

Finally, CMS ruled that the use of FDG PET/CT to guide treatment for patients with prostate cancer can be applied when reasonable and necessary. “Monitoring metastatic prostate cancer therapy can be difficult. However, in some indications PET can provide useful information for physicians in creating an effective treatment plan,” said Dillehay.