SNM and other imaging groups ask CMS to reconsider coverage decision to include 2 FDG-PET scans
Seven medical imaging groups wrote a joint letter to the Centers for Medicare and Medicaid Services (CMS) to formally request coverage of two fluorodeoxyglucose (FDG) positron emission tomography (PET) scans for a patient during the initial treatment evaluation. Currently, CMS covers only one FDG-PET study during initial treatment-a limitation that the groups believe is contrary to good clinical practice under certain circumstances.
"It is absolutely critical for CMS to reconsider this decision," said Michael M. Graham, Ph.D., M.D., president of SNM and director of nuclear medicine at the University of Iowa Carver College of Medicine in Iowa City. "It is unacceptable to have reimbursement for only one scan when you need two in order to assess efficacy of treatment."
The letter--which was signed by the leadership of the National Oncologic PET Registry (NOPR) Working Group, the Academy of Molecular Imaging, the American College of Nuclear Medicine, the American College of Radiology, the American Society for Radiation Oncology, the Institute for Molecular Technologies and SNM--presents CMS with three practical scenarios in which a second initial FDG-PET scan would be necessary for optimal patient care. The first example is when PET is used for the diagnosis or staging of a tumor and the course of treatment is determined to be radiation therapy. In certain circumstances, a second PET scan may be needed for successful radiation therapy planning.