Medicare News
| For Immediate Release: | Contact: |
| Monday, March 08, 1999 | CMS Office of Public Affairs 202-690-6145 |
For questions about Medicare please call 1-800-MEDICARE or visit www.medicare.gov. |
|
POSITRON EMISSION TOMOGRAPHY (PET) SCAN COVERAGE EXPANDED
Following an expedited review of scientific information presented at a January town hall meeting, the Health Care Financing Administration (HCFA) today announced a national decision to cover additional uses of positron emission tomography (PET) scans to diagnose and manage certain cancers in Medicare beneficiaries.
Medicare already covers PET scanning for the diagnostic evaluation of solitary pulmonary nodules and for staging non-small cell lung cancer. Three new oncology indications will now be covered: detection and localization of recurrent colorectal cancer with rising carcinoembryonic antigen known as CEA; staging and characterization of both Hodgkins and non-Hodgkins lymphoma in place of a gallium scan or lymphangiogram; and identification of metastases in melanoma recurrence in place of gallium studies.
The Jan. 20-21 town hall meeting held by HCFA brought together clinical experts, consumer advocates, medical equipment manufacturers and others to discuss the use of PET scanning for the evaluation and management of head and neck, brain and colorectal cancers; melanoma; and lymphoma. HCFA staff have been working collaboratively with interested parties to review scientific information about oncology indications for PET scanning since 1997.
"The town hall meeting was an excellent way to obtain the latest information about the effectiveness of PET scanning as a diagnostic and management tool for oncology patients," said Mitchell Burken, M.D., a medical officer in the Coverage and Analysis Group within HCFA's Office of Clinical Standards and Quality. "We will continue to review information presented at the meeting about other potential oncology indications for PET, but we believe that these three indications have obvious clinical utility and wanted to take immediate steps to begin initiating Medicare coverage."
PET is a non-invasive imaging procedure that assesses metabolic activity in different parts of the body. A positron camera is used to produce cross-sectional images of the body by detecting radioactivity from a radioactive tracer substance injected into the patient.
"As scientific evidence becomes available showing the effectiveness of new technologies, HCFA wants to act as quickly as possible to make sure Medicare beneficiaries have access to safe and effective new technologies," said Jeffrey Kang, M.D., HCFA's chief medical officer and director of the Office of Clinical Standards and Quality.
While most Medicare coverage decisions are made locally by HCFA contractors -- the private companies that by law process and pay Medicare claims -- HCFA makes national coverage decisions that apply nationwide and supersede local policies. HCFA will next issue a coverage instruction, including coding and billing information, to all of its contractors that will specify an effective date when Medicare payment for additional PET scan indications will be available.
