PET proponents got good news and bad on the reimbursement front this week, with the Centers for Medicare and Medicaid Services (CMS) announcing that it will begin Medicare reimbursement coverage for some new indications, but that others aren't ready for prime time.
CMS will expand coverage for the use of PET to diagnose thyroid cancer and potential cardiac diseases. The agency also said it is designing a demonstration study to evaluate the potential role of PET for patients with suspected dementia, and convening a multidisciplinary meeting of experts to fully explore the value of PET for Alzheimer’s disease.
CMS said it has reviewed the scientific evidence for the radiopharmaceutical ammonia N-13 as a myocardial perfusion tracer -- in combination with FDG as the viability tracer -- in PET imaging, and has determined that it will be covered under the Medicare program.
The agency will also cover the use of PET to stage thyroid cancer. This decision was reached after an exhaustive evidentiary review of the medical literature, a technology assessment, and recommendations from the CMS Medicare Coverage Advisory Committee, CMS said.
Yet PET's proponents were dealt a setback with the latest round of CMS coverage decisions for the modality, however, as the agency decided against extending Medicare coverage at this time for soft-tissue sarcoma. The agency said its review of the evidence found that PET did not improve patient outcomes in this group.
Advocates for the use of the modality for early detection of Alzheimer’s will have to wait for CMS coverage of PET for this disease. Although the agency said the clinical benefit to patients has not been demonstrated, it did agree to further investigate PET’s role for patients with suspected dementia.
CMS said it would work with the National Institutes of Health to convene a multidisciplinary expert meeting with geriatricians, neurologists, radiologists, PET experts, and patient advocates to fully explore the value of PET for Alzheimer’s disease.
By AuntMinnie.com staff writersApril 17, 2003
Related Reading
CMS sets date for expanded MRA coverage, April 17, 2003
CMS to determine additional PET reimbursement, February 28, 2003-04-17
U.S. CAD reimbursement increased, February 27, 2003
Physician groups navigate a rocky road to PET reimbursement, February 26, 2003
CMS publishes final Medicare rule with 4.4% fee cut, December 12, 2002
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