UPDATE:
November 10, 2009

CMS Expands Coverage for Cervical Cancer

On November 10, 2009, CMS posted a final decision memorandum Decision Summary to follow:

CMS was asked to reconsider Section 220.6 of the National Coverage Determinations Manual to end the prospective data collection requirements for FDG PET for initial staging of cervical cancer. CMS has concluded that the evidence is adequate to determine that the results of FDG PET imaging for cervical cancer staging of beneficiaries diagnosed with cervical cancer are used by the treating physician to make meaningful changes in therapeutic management and improve health outcomes, and thus are reasonable and necessary under §1862(a)(1)(A) of the Act.

Therefore, CMS will cover only one FDG PET for staging for beneficiaries who have biopsy proven cervical cancer when the beneficiary's treating physician determines that the FDG PET study is needed to determine the location and/or extent of the tumor for the following therapeutic purposes related to the initial treatment strategy:

• To determine whether or not the beneficiary is an appropriate candidate for an invasive diagnostic or therapeutic procedure; or
• To determine the optimal anatomic location for an invasive procedure; or
• To determine the anatomic extent of tumor when the recommended anti-tumor treatment reasonably depends on the extent of the tumor.

UPDATE:
April 6, 2009

CMS News: Medicare Expands Coverage of PET Scans as Cancer Diagnostic Tool (4/6/09)

CMS issued a press release on April 6, 2009 concerning its April 3, 2009 decision to expand coverage for PET scans as a cancer diagnostic tool under its Coverage with Evidence Development project. CMS cited the work of the NOPR in its decision to modify its 2005 coverage policy. “This decision is the first time that CMS has reconsidered a coverage policy based on new evidence developed under the CED program.” Click Here for more information.

As NOPR announced on April 3, 2009, CMS has expanded coverage for the use of PET for initial treatment strategy evaluation (formerly diagnosis and initial staging) of patients with nearly all cancer types, and also will allow for use of PET in subsequent treatment strategy evaluations (formerly restaging, detection of suspected recurrence and treatment monitoring) for an expanded number of cancer types. However, for certain other cancers, the use of PET in initial treatment strategy evaluations and, particularly, in subsequent treatment strategy evaluations will still be covered by CMS only if patients are enrolled in an approved clinical trial or registry such as the NOPR.

Click here for list of Medicare Covered Indications

NOPR

The National Oncologic PET Registry (NOPR) was developed in response to the Centers for Medicare and Medicaid Services proposal to expand coverage for positron emission tomography with F-18 fluorodeoxyglucose (PET) to include cancers and indications not presently eligible for Medicare reimbursement. Medicare reimbursement for these cancers can now be obtained if the patient's referring physician and the provider submit data to a clinical registry to assess the impact of PET on cancer patient management. The NOPR is implementing this registry for CMS. The NOPR is sponsored by the Academy of Molecular Imaging and managed by the American College of Radiology through the American College of Radiology Imaging Network.

Alzheimers CMS coverage

Medicare may provide coverage for Alzheimer’s Disease versus Fronto-Temporal Dementia. Differential diagnosis of Alzheimer’s Disease and fronto-temporal dementia, where patient has had a recent diagnosis of dementia, cognitive decline for six months, and a standard clinical evaluation, yet a diagnosis of AD remains uncertain.

Ask your Family Practice Physician what Medicare requires for approval. Click here for more info