Societies request CMS coverage for two PET scans

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Seven medical imaging societies have written a joint letter asking the Centers for Medicare & Medicaid Services (CMS) to provide coverage for two FDG PET scans for initial patient treatment evaluation, as opposed to the one scan CMS now covers.

The imaging groups—the National Oncologic PET Registry (NOPR) Working Group, the Academy of Molecular Imaging (AMI), the American College of Nuclear Medicine, the American College of Radiology (ACR), the American Society for Radiation Oncology (ASTRO), the Institute for Molecular Technologies and SNM (formerly the Society of Nuclear Medicine)—believe that the one-scan limit is contrary to good clinical practice in certain circumstances.

The letter outlined three circumstances in which a second scan would be necessary:

  • When PET is used for the diagnosis or staging of a tumor and the treatment elected is radiation therapy.
  • If PET is used to evaluate a lesion and the results come back false-negative and the patient is later diagnosed with cancer, a second PET would be necessary for initial staging before treatment.
  • If a patient with newly diagnosed cancer has to delay treatment for some reason, such as the need to address another illness first, a second scan might be needed to evaluate the disease after a passage of time.

"It is absolutely critical for CMS to reconsider this decision," said Michael M. Graham, PhD, MD, president of SNM and director of nuclear medicine at the University of Iowa Carver College of Medicine in Iowa City, Iowa. "It is unacceptable to have reimbursement for only one scan when you need two in order to assess efficacy of treatment."