CMS Proposes to Allow Local Coverage of PET in Cancer Care

January 12, 2013


The Centers for Medicare and Medicaid Services (CMS) has proposed allowing Medicare contractors to make local coverage decisions when PET scans using radiopharmaceuticals approved by the Food and Drug Administration are used in cancer care. CMS will accept comments on its proposal through January 12, 2013.


CMS currently provides national coverage of certain radioisotopes for specific defined uses of PET. Other uses with these radioisotopes are specifically non-covered nationally by CMS or are covered only when furnished in clinical studies under the CMS coverage with evidence development (CED) policy.


The new CMS proposal would, in effect, remove statements from these existing policies that have had the effect of denying the possibility of local coverage of certain uses of PET tracers, including radiopharmaceuticals approved in the future. Therefore, local contractors could decide on their own to cover or not cover locally.


Follow this link to the full text of the proposed decision memo

Click here for the full text of the proposed decision memo