CMS reconsidering certain PET reimbursement

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The Centers for Medicare and Medicaid Services (CMS) have accepted a proposal for the agency to consider establishing a national coverage policy for the diagnostic evaluation of patients with suspected infectious and inflammatory disorders.

The requesters—Abass Alavi, MD, professor of radiology, chief, Nuclear Medicine Section, University of Pennsylvania; and Javad Parvizi, MD, associate professor of orthopedic surgery, Thomas Jefferson University—said that FDG-PET’s diagnostic efficacy is particularly well-established for chronic osteomyelitis, infection associated with hip arthroplasty and fever of unknown origin. Plus, each of these conditions disproportionately afflict the Medicare population. “FDG-PET is significantly more sensitive and specific for detecting infection and inflammation than are conventional imaging techniques,” they wrote.

CMS opens this reconsideration of the NCD on Positron Emission Tomography (PET). The formal request is to remove the current de facto non-coverage for PET for the requested indications. The initial 30-day public comment period began on June 25 and ends on July 25. The expected NCA completion date is March 24, 2008.