Robert W. Atcher, PhD, SNM immediate past-president

The determination made by the Centers for Medicare & Medicaid Services (CMS) on the reimbursement for NaF-18 (sodium fluoride-18) PET imaging to identify bone metastasis of cancer is "progress," said Robert W. Atcher, PhD, immediate past-president of SNM (formerly the Society of Nuclear Medicine), in an interview.

Commenting on the Nov. 30 draft memorandum proposed by CMS, Atcher said, “[I]t’s progress—they are continuing to consider the request to reimburse for NaF-18 PET imaging for bone scans—It’s not a final decision and we are moving forward with the process, which is good news for us."

“In our discussions with CMS, after we had the problems with the reactor in Canada, it was obvious that one of the areas to be affected was bone scans, as we did not have any viable options in the U.S. CMS offered to reimburse under the coverage with evidence development, which is the same mechanism used for the NOPR study," said Atcher, who also is the team leader for emerging medical technology with Los Alamos National Laboratory in New Mexico.

Atcher added that the "good news is they will reimburse for the bone scans and at the same time, we will be in a position to gather data to demonstrate the value of NaF-18 PET imaging to CMS. From that standpoint, we are in much better shape than we are right now which is having no coverage whatsoever for NaF-18 PET imaging.”

The decision to reimburse for NaF-18 PET imaging is taking a longer time due to the lack of recent published literature. Atcher explained that there was fair amount of data published 30 years ago when people were using NaF-18 to image with rectilinear scanners and when the anchor camera came into use, the photon images were no longer taken which pushed the use of technetium compounds.

“There still haven’t been any really good NaF-18 PET studies published in the recent past that would provide enough evidence to support them making the whole decision to reimburse for PET. The National Cancer Institute has trials going on comparing PET imaging and there are few others going as well to look at the advantages to NaF-18 over technetium, which will be the quickest way to get CMS to reimburse.”

Both Europe and Canada agreed in light of the molybdenum shortage to reimburse for NaF-18 PET scans. “In that sense, the U.S. is lagging— we are the first world country in not providing that option,” said Atcher.

Atcher predicted that CMS is moving forward by opening the last comment period which is due by Dec. 30. “From that standpoint we can’t predict whether they are going to move forward with the coverage with evidence development but the fact is there wasn’t anything in the initial fact finding that indicated to them that they shouldn’t move forward,” he noted.