CMS Proposes Expanding Medicare Coverage of PET Scans in Cancer Patients

The Centers for Medicare and Medicaid Services (CMS) has issued a national coverage determination (NCD) that would expand Medicare coverage of PET scans as an initial diagnostic test for cancer patients. Under an existing NCD issued in 2005, Medicare only covers such PET scans for certain cancers if the treating physician and patient agree to submit data on the scans to a clinical registry.

The registry, the National Oncologic PET Registry (NOPR), was organized as a result of a collaboration among CMS and several radiology- or cancer-related professional associations. It was the first such registry established under CMS’ Coverage with Evidence Development program, the goal of which is “to develop evidence on the utilization and impact of the item or service evaluated in an NCD,” according to a CMS statement.  

The proposed NCD would lift the requirement for submission of data to the NOPR for the first PET scan intended to guide the course of a patient’s treatment. The proposal follows an analysis of NOPR data published last spring, which found that PET scan results altered how physicians intended to manage patients more than one-third of the time, including the type of treatment they would prescribe.

CMS is accepting public comments on the proposed NCD through February 5, 2009.