Use of PET scans to diagnose and determine initial treatment for most solid-tumor cancers will be automatically covered under Medicare, according to a national coverage determination memo issued by the CMS.
The agency announced in January that it was considering the move as a result of data collected through the Coverage with Evidence Development programs National Oncologic PET Registry observational study. The decision removes a previous requirement that patients receiving PET scans for cancer diagnosis be enrolled in the study in order for Medicare to cover the procedure. The Coverage with Evidence Development program allowed us to cover an emerging technology, learn more about its usage in clinical practice, and adjust our coverage policies accordingly, acting CMS Administrator Charlene Frizzera said.
The decision will allow automatic coverage of PET scans when used as an initial diagnostic tool to determine tumor size, whether lesions are benign or cancerous and whether a cancer has metastasized. Coverage will also be expanded to include use of PET scans in subsequent treatment-strategy evaluation for 11 cancers, including ovarian, cervical and myeloma cancers, according to CMS officials.