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CMS expands coverage of PET scans for the diagnosis, treatment of most solid tumor cancers
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Medicare beneficiaries with certain solid tumor cancers are now covered for initial testing with PET scans, according to a final National Coverage Determination from The Centers for Medicare and Medicaid Services.
Since 2005, Medicare coverage of PET scans used to diagnose some cancers and steer treatment of other types required that providers collect clinical information about how the scans affected treatment decisions. The data were gathered through the National Oncology PET Registry observational study. This final National Coverage Determination lifts this requirement.
Medicare collects data from the National Oncologic PET Registry under the CMS’ Coverage with Evidence Development program. The program allows Medicare to develop evidence about how a medical technology is used in clinical practice. The data are used to clarify the effect on the Medicare beneficiaries’ health; consider future changes in coverage for the technology; and generate clinical information to improve the evidence base providers use to make recommendations to Medicare beneficiaries regarding the technology.
The current decision was driven partly by information gathered since the 2005 decision to require data reporting for PET scans. According to a press release, this is the first time the CMS has reconsidered a coverage policy based on new data developed under the CED program.
The expansion includes PET scans used to support initial diagnosis and treatment for most types of solid tumor carcinomas. PET scans for subsequent follow-up testing in beneficiaries with cervical or ovarian cancer and those who are treated for myeloma will no longer require NOPR data collection. However, data reporting is still required when using PET to monitor treatment progress or cancer remission.