CMS changes course on FDG-PET, will pay for three scans

The Centers for Medicare & Medicaid Services--responding to concerns levied by medical imaging groups--issued a final decision on coverage of oncology FDG-PET scans in which it determined that it will pay for three follow-up scans instead of just one, as initially proposed several months ago.

Under the final rule, coverage of any additional scans beyond the three will be determined by local Medicare Administrative Contractors. In addition, CMS' decision means that the use of FDG PET/CT, when used to guide subsequent anti-tumor strategies for patients with prostate cancer, should remain at the local contract level.

According to the decision memo, CMS received 175 comments opposing the proposed one-scan limitation of covered FDG-PET scans, with many remarking that three scans was typical for patients undergoing a second- or third-line cancer treatment.

"CMS appreciates these comments and will nationally cover at least three additional scans," the decision memo stated. "Coverage of additional scans [that is, more than three] shall be determined by the local MACs."

Several medical imaging organizations, including the Medical Imaging Technology Alliance and the Society of Nuclear Medicine and Molecular Imaging, expressed relief that CMS had changed its mind.

"MITA has long supported Medicare coverage decisions that facilitate access to PET imaging, which has revolutionized the diagnosis, treatment and monitoring of a wide range of diseases," Gail Rodriguez, executive director of the Medical Imaging Technology Alliance, said in a statement. "This final decision on FDG-PET for solid tumors is a step in the right direction in ensuring access to critical imaging procedures for patients with cancer."

SNMMI President-elect Hossein Jadvar added in a statement that while his organization appreciates CMS' change of heart, "it will be important for the local contractors to allow more than three when clinically necessary."

To learn more:
- check out the CMS final decision memo
- here's the statement from MITA
- see the SNMMI statement

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