The Centers for Medicare & Medicaid Services announced Friday that it is removing the national coverage determination for beta-amyloid PET scans, thereby broadening access to this vital imaging exams.
CMS first hinted at the move back in July when it proposed potentially lifting the longstanding policy that restricts patients to one amyloid-detecting positron emission tomography exam in their lifetime. Friday’s elimination of the previous “coverage with evidence development” requirement allows local Medicare Administrative Contractors to dictate coverage for such exams.
Imaging advocates, who have pushed for this change for years, praised CMS on Friday.
“This decision ensures increased accessibility to this crucial nuclear medicine test for eligible patients and facilitates the targeted use of new treatments for those who can benefit,” Helen Nadel, MD, president of the Society of Nuclear Medicine & Molecular Imaging, said in a statement.
“Numerous published studies involving thousands of patients clearly support that beta-amyloid PET scans improve the clinical management of patients with cognitive impairment,” Patrick Hope, executive director of the Medical Imaging & Technology Alliance, which represents device manufacturers, said in a separate statement. “So, it is a welcome decision to retire [coverage with evidence development] and expand access to beta-amyloid PET imaging.”
SNMMI noted that this decision will be especially beneficial for patients receiving monoclonal antibody treatments for Alzheimer’s. To ensure proper administration of such drugs, the society said individuals should receive an initial PET scan to confirm amyloid plaque buildup in the brain. Additional exams should follow to monitor reductions in plaque levels.
The nuclear medicine society said it continues urging CMS to retire or eliminate other “outdated” PET coverage determinations that “inappropriately restrict coverage.” MITA also emphasized that MACs should work with experts in neurology and Alzheimer’s disease to ensure “seamless and consistent coverage” for amyloid PET in different jurisdictions.
You can find the full national coverage determination from CMS here.
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.