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CMS releases final coverage decision on FDG-PET

by Loren Bonner, DOTmed News Online Editor | June 13, 2013
The Centers for Medicare and Medicaid Services released its highly anticipated final decision June 12 on how it will proceed with Medicare coverage for oncologic uses of FDG-PET imaging devices.

CMS removed the long-standing "coverage with evidence development" (CED) requirement, which covers one FDG-PET scan post-treatment for solid tumors, and instead will provide coverage for three subsequent scans following completion of initial anti-cancer therapy.

The decision was welcome news to many industry stakeholders.

"This final decision on FDG-PET for solid tumors is a step in the right direction in ensuring access to critical imaging procedures for patients with cancer," said Gail Rodriguez, executive director of the Medical Imaging & Technology Alliance (MITA).

In advance of CMS' final decision, the health care consulting firm Avalere Health conducted an analysis of the 201 comments filed on the proposed coverage decision and found that 97 percent (195 out of 201) opposed CMS' proposal to limit national coverage of FDG-PET to one scan to guide subsequent anti-tumor treatment. According to Avalere, the respondents urged CMS to reconsider its decision and broaden coverage of FDG-PET.

On the opposite side of the fence, America's Health Insurance Plans expressed support of increased coverage restrictions for FDG-PET, stating that there is inadequate evidence to justify coverage of any post-treatment scans, according to Avalere.

The final CMS decision also reversed the initial proposal not to cover FDG-PET for prostate cancer nationally. As a result, the use of FDG-PET to guide subsequent anti-tumor treatment strategy for patients with cancer of the prostate will remain at the local contractor level, according to MITA.

FDG-PET is a minimally invasive diagnostic imaging procedure used to evaluate glucose metabolism in normal tissue, as well as in diseased tissues such as cancers.

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