BALTIMORE, April 7 -- The Centers for Medicare and Medicaid Services announced expanded coverage of PET scans for Medicare patients suspected of having most cancers.
Medicare already covers initial PET scans for cervical, colorectal, esophageal, head and neck, lymphoma, melanoma, non-small cell lung, and thyroid cancers. In addition, breast cancer has been covered for staging distant metastasis at initial diagnosis. CMS will now reimburse for subsequent scans in patients with those cancers.
It will also add two new malignancies -- ovarian cancer and myeloma -- to its list, which makes for a total of eleven cancers now covered for both the initial diagnosis and subsequent treatment strategy for patients.
The decision will allow coverage for one PET scan to guide the initial treatment strategy for Medicare patients with most types of solid tumors that are biopsy-proven or strongly suspected based on other diagnostic testing, according to CMS.
Additional scans for subsequent follow-up testing in patients with cervical or ovarian cancer, or who are being treated for myeloma, will be covered.
PET scans will not be covered for prostate cancer or to evaluate regional lymph nodes in melanoma.
Use of PET for initial breast cancer diagnosis and initial staging of axillary nodes will remain uncovered as well, the agency said.
CMS began studying the impact of PET scans on cancer care in 2005, tying Medicare coverage to the collection of data through the National Oncologic PET Registry (NOPR) study, which was designed to gather evidence to support expanded Medicare coverage.
Studies of the registry, which analyzed data from more than 41,000 patients, showed that PET changed cancer treatment plans in more than one out of three cases. The decisions moved from nontreatment to treatment more than three times as often as the reverse. (See: PET Changes Cancer Treatment in More than a Third of Cases)
The Society of Nuclear Medicine issued a statement calling the CMS decision "a major victory for cancer patients." It said the decision increases the likelihood that private insurers will eventually follow CMS' lead and reimburse for PET scans for a variety of cancers.
Primary Source
Centers for Medicare and Medicaid Services
Source Reference: "Decision Memo for Positron Emission Tomography (FDG) for Solid Tumors (CAG-00181R)"