CMS seeks public comment on retiring current PET coverage framework

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New framework may include more widespread PET coverage for various cancers. Image Source: Encyclopedia of Children's Health  

The Centers for Medicare & Medicaid Services (CMS) has been asked by representatives from the National Oncologic PET Registry (NOPR) to remove the current prospective data collection requirements as required for certain cancers in Section 220.6 of the national coverage determination (NCD) manual for PET reimbursements.

“We have received public input indicating that the current coverage framework which required cancer-by-cancer consideration of diagnosis, staging, restaging and monitoring response to treatment should be replaced by a more omnibus consideration,” according to CMS. “Though that coverage framework has been useful, we are open to public input that it be retired and that a general policy could be developed and applied to oncologic FDG-PET imaging.”

The agency currently uses a cancer-by-cancer methodology to determine whether to expand coverage of FDG-PET in solid tumors. Since 2006, Medicare has only covered patients with other cancers, including brain, cervical, bladder, small-cell lung, ovarian, testicular, prostate, kidney and pancreatic cancers, if they were enrolled in the registry.

CMS convened the Medicare Evidence Development and Coverage Advisory Committee on Aug. 20 to review the scientific evidence of the impact of PET as part of a cancer management strategy to improve patient-centered outcomes. The panel also considered data generated pursuant to prior NCD to cover PET for specified cancers when additional data are prospectively collected.

The initial 30-day public comment period began Tuesday, and ends Oct. 17. The new review will come under the heading of "NCA Tracking Sheet for PET FDG for Solid Tumors (CAG-000181R)."

CMS is expected to release a proposed decision memo by January 2009, with an expected completion date in April 2009.