Medicare Expands Coverage of PET Scans for Most Solid Cancers
Medicare will now cover PET scans as an initial diagnostic test for cancer patients, the Centers for Medicare and Medicaid Services (CMS) announced on April 3. Under the national coverage determination (NCD), treating physicians will no longer have to submit PET scan data to the National Oncologic PET Registry (NOPR) for diagnosing and staging most solid tumors.
The requirement to submit data to the NOPR, instituted in 2005, was the first such effort under CMS' Coverage with Evidence Development (CED) program. An analysis of NOPR data published last spring 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. "CED allowed us to cover an emerging technology, learn more about its usage in clinical practice, and adjust our coverage policies accordingly," said CMS Acting Administrator Charlene Frizzera.
The NCD also covers PET scans for subsequent follow-up testing in Medicare beneficiaries being treated for cervical cancer, ovarian cancer, and myeloma. CMS will still require treating physicians to submit PET scan data to the NOPR from scans conducted to monitor the progress of treatment and remission of some cancers.