CMS opens door to cancer-related PET coverage

PET equipment manufacturers from GE Healthcare to Philips and others will benefit from a new CMS coverage decision that will help expand access to the nuclear medical imaging technique for cancer patients. But the industry's major lobbying group wanted the government to go much further than it did.

Essentially, the Centers for Medicare & Medicaid Services removed its national non-coverage decision for positron emission tomography scanning for oncology applications. Instead, according to the agency's March 7 decision memo, local Medicare contractors can decide on cancer imaging coverage in their individual jurisdictions. CMS reimbursement is often a crucial ingredient for medical imaging manufacturers seeking broader use of their products in medical care.

The CMS move represents a partial victory for the Medical Imaging & Technology Alliance, which wanted local Medicare contractors to gain wide approval to determine the use of new FDA-approved radio-pharmaceuticals for PET scanning for a variety of diseases. Previously, PET scanning has generally faced CMS non-coverage decisions, with a few exceptions. (PET uses a positron camera to measure the decay of these radiopharmaceuticals in human tissue in order to help diagnose, monitor and treat a variety of diseases.)

MITA Executive Director Gail Rodriguez acknowledged the revised decision in a statement, noting that the action will give both doctors and patients access to "cutting edge" PET imaging tools for both cancer detection and treatment. But, Rodriguez added, she had hoped the agency would go further.

"We are encouraged that CMS has taken an important first step in covering PET procedures," she said, "but disappointed that broader PET coverage decisions for cardiac and neurological applications were not included in this decision. MITA is concerned that CMS stopped short of our complete request, which called for local coverage of all PET tracers that are newly approved by the FDA, not just oncologic tracers."

This isn't over. The push to expand coverage for PET imaging even further is likely to come up again in the future.

- read the CMS decision memo
- and the MITA press release

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