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CMS Reviews FDG PET Coverage  

October 23, 2013

 

The Centers for Medicare and Medicare Services is reviewing whether to change its current coverage policy that requires registry data to be collected when FDG PET imaging is used in planning treatment for certain types of cancer. A wide range of medical groups and experts, including the organization in charge of collecting the registry data, are supporting the change.

 

The requirement for data collection was included in a 2005 CMS decision which found that insufficient data existed to support coverage of FDG PET in planning treatment for a number of less common types of cancer. CMS used its coverage with evidence development authority to allow such coverage, but only when clinical data were collected and submitted to a registry.

 

In 2009, CMS lifted the requirements when FDG PET is used in evaluating initial treatment strategy for most oncologic indications, but continued to require it for subsequent treatment strategy. The organization created to manage the registry, the National Oncologic PET Registry (NOPR), requested that the restrictions be lifted on use of such scanning for subsequent treatment strategy because the data showed that it was associated with a 35% change in how physicians managed patient care.

 

Click to see NOPR letter

 

Click to see the CMS coverage page