PET Medicare decision doesn't go far enough, medical device makers say

March 12, 2013 by Arezu Sarvestani

The Centers for Medicare & Medicaid lift a non-coverage decision for positron emission tomography in oncologic uses, but that's not enough for the Medicare Imaging & Technology Alliance.

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The Center for Medicare & Medicaid Services announced a shift in their decision regarding reimbursement for positron emission tomography scanning that will open the door for states to make their own coverage decisions for PET.

Lobbying group Medical Imaging & Technology Alliance supported the move, but chided the agency for failing to make the decision universal. CMS applied the shift specifically to oncologic tracers, despite MITA's request.

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"MITA is concerned that CMS stopped short of our complete request, which called for local coverage of all PET tracers that are newly approved by the FDA, not just oncologic tracers," MITA executive director Gail Rodriguez said in prepared remarks. "We are disappointed that these applications were not included in the decision memorandum and believe that the consideration of coverage for PET tracers should be no different than for other items and services."

MITA remains hopeful that CMS will "continue to evaluate the preponderance of evidence that guides physician utilization of PET tracers in specialties outside of oncology in order to avoid lengthy, bureaucratic reviews of items and services that are rapidly becoming the standard of care."

PET imaging is used to scan tissue in treatment and analysis of cancer, ischemic heart disease and certain neurological disorders, according to the CMS note. The technology is generally not reimbursed, with the exception of some radioactive tracers.