The U.S. agency that administers the Medicare and Medicaid programs has ruled out reimbursement for most PET studies conducted on gamma cameras rather than dedicated PET systems. The ruling is a blow to nuclear medicine advocates, who had hoped that the agency would adopt a more liberal standard when paying for PET exams.
The Centers for Medicare and Medicaid Services (CMS) said on June 29 that gamma camera-based PET systems will not be included in the most recent expansion of clinical PET applications eligible for Medicare reimbursement. This expansion, which was announced in December 2000 and went into effect on July 1, includes non-small cell lung cancer, colorectal cancer, Hodgkin's and non-Hodgkin's disease, melanoma, and certain head and neck cancers.
In making its decision, the agency said that evidence it has reviewed indicates that coincidence detection PET as conducted on gamma cameras does not measure up to the gold standard of a PET camera with a full ring of detectors. "The existing literature shows that camera-based systems miss a non-trivial number of small but potentially clinically significant malignant lesions compared with full-ring PET scanners," the agency said.
CMS said it would allow Medicare reimbursement for gamma camera PET for applications that were already covered prior to the December 2000 decision. However, such studies must be conducted on a camera with digital detectors, 5/8-inch crystals, techniques for randoms and scatter correction, and iterative reconstruction algorithms.
CMS said it would review its decision after December 31, 2002. It said it would reconsider the ruling if gamma camera-based PET were able to demonstrate performance equivalent to or better than full-ring PET, or if clinical studies indicate that gamma camera-based PET provides diagnostic information that adds to or replaces information provided by conventional imaging.
By AuntMinnie.com staff writersJuly 10, 2001
Related Reading
HCFA expands covered uses for PET, but hedges on coincidence cameras, April 12, 2001
HCFA broadens Medicare coverage for PET, December 18, 2000
Dedicated PET and hybrid PET are equally accurate for assessing lung cancer, October 25, 2000
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