The Centers for Medicare & Medicaid Services (CMS) is changing its standards on reimbursing PET exams. CMS said it plans to reimburse a broad range of oncology studies with positron emission tomography (PET), provided the procedures are performed in a deemed clinical trial or data is submitted to a specified registry.
Under the new system, CMS will reimburse for PET (or PET-CT) that is utilized in evaluation of patients with cervical cancer and will also cover PET for brain, pancreatic, ovarian, small cell lung, and testicular cancers, as well as for a broad range of other cancers. The registry will be managed and the resultant data analyzed by American College of Radiology Imaging Network (ACRIN), working jointly with Academy of Molecular Imaging (AMI) investigators.
Referring physicians will complete surveys that will be submitted electronically to ACRIN and stored in ACRIN archives, prior to and following PET scans. ACRIN/AMI investigators will analyze the data to determine if PET had a significant impact on the referring physicians' clinical decision-making.
The data collected as part of the policy will help ensure the PET information is used accurately and appropriately in patient management and will also help doctors and Medicare beneficiaries make better-informed choices about their health care.
Medicare coverage for the added indications will become effective when the resulting registry is implemented in late spring 2005.
"The Society of Nuclear Medicine (SNM) applauds this move by CMS to recognize the value of PET in the co-management of the nation's cancer patients," said SNM's President Mathew L. Thakur, PhD, in a prepared statement.
"This action will give thousands of cancer patients the benefit of the superior diagnosis and treatment capabilities of this exciting imaging technology," agreed Peter S. Conti, MD, PhD, SNM president-elect and chair of SNM's PET Center of Excellence.
The expansion in PET scan benefits makes this test available to patients when the patient and doctor participate in high-quality clinical studies or submit information to a PET database. The database will be available within the next several months.
CMS said it plans to hold an open door forum Feb. 14 on the topic to obtain public input on linking coverage to practical trials and databases.