Associations call for CMS to adopt omnibus cancer coverage PET framework

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In response to a data collection effort by the National Oncologic PET Registry (NOPR) showing that PET scans can help improve cancer patient survival, the Centers for Medicare & Medicaid Services (CMS) should consider the expansion of coverage of PET for all types of cancer, according to the Society of Nuclear Medicine (SNM) and other nonprofit medical associations.

The PET coverage comment period ended Oct. 17, and a decision is expected early next year.

NOPR was developed in response to a proposal from CMS to expand coverage for PET—using the radiotracer FDG-PET—to include cancers and indications not presently eligible for Medicare reimbursement, including cancers of the ovary, uterus, prostate, pancreas, stomach, kidney and bladder. Medicare reimbursement for the cancers was provided if the patient's referring physician and provider submitted data to NOPR to assess the impact of PET on cancer patient management.

“We believe it essential for patients that CMS adopt a comprehensive reimbursement policy for PET,” said SNM President Robert W. Atcher, PhD. “We applaud CMS' decision to consider broadening coverage for PET…Molecular imaging techniques, such as PET, can pinpoint the precise location of disease, give us specific information on the metabolic and physiologic status of the disease and enable physicians to target treatment and prevent unnecessary surgery.”

In submitting comments to CMS, US Oncology Physicians Network expressed its belief that it is both clinically appropriate and practical for CMS to adopt an omnibus cancer coverage framework for PET. The physicians’ network said that “patients with less common cancers included in the NOPR comprise about 10 percent of the Medicare population imaged by PET in 2006-2008.”

Based on the data from the NOPR and the clinical and scientific publications on PET, US Oncology Physicians said it will “strongly support an effort by CMS to update and modernize the current PET NCD policy to allow for the coverage of PET for diagnosis, staging, and restaging/suspected recurrence purposes for oncologic indications.”

Of the 1,598 registered NOPR sites, 61 were US Oncology network practices and as many as 10 percent of patients who received NOPR trial studies were from US Oncology network practices.

In response to this positive data, NOPR formally asked CMS to reconsider the current National Coverage decision on oncologic use of FDG-PET and to end the data collection requirements for diagnosis, staging and restaging. CMS issued a Call for Comments for interested parties, including physicians, advocacy groups and imaging societies, to contribute additional information prior to a final reimbursement decision.