The American College of Radiology (ACR) strongly supports the Centers for Medicare & Medicaid Services (CMS)’ determination to significantly expand coverage of positron emission tomography (PET) scans performed in both the initial and subsequent evaluation of patients with many types of cancer. PET scans for many cancers were previously reimbursed only if the facility submitted data to the NOPR registry.
Now, Medicare patients with essentially all cancers can receive Medicare coverage for at least one PET scan prescribed by their physicians for initial treatment strategy evaluation. In addition, PET is also now covered for 11 cancer types for subsequent treatment strategy evaluation. These cancers are breast, cervix, colorectal, esophageal, head and neck, lymphoma, melanoma, non-small cell lung, thyroid, myeloma and ovary. Patients with these cancers represent the vast majority of cancer patients in the Medicare system. For all other cancers, PET coverage for subsequent treatment strategy evaluation requires participation in an approved Coverage with Evidence Development (CED) program. The NOPR can, with planned modifications, continue to serve this function for those PET studies still requiring CED.
The CMS move is based on significant clinical evidence regarding the effectiveness of PET for management of patients with cancer gleaned from the National Oncologic PET Registry (NOPR) which is co-managed by the ACR and ACRIN.
”Expanded CMS coverage for PET is a tremendous step forward for cancer care in this country. The NOPR is a shining example of how the medical community can interact with government on research that can ultimately save and extend patients’ lives,” said James H. Thrall, M.D., FACR, chair of the ACR Board of Chancellors, Radiologist-in-Chief, Massachusetts General Hospital, and Professor of Radiology, Harvard Medical School.
“NOPR data undoubtedly served a primary role in this CMS decision, which will allow seniors far greater access to PET imaging to guide their care. The registry provided undeniable evidence that PET scans can serve a vital role in diagnosing, staging, restaging and monitoring treatment for patients with many types of cancer. We are proud that NOPR efforts have enabled CMS take this very important step to help cancer patients nationwide,” said Barry Siegel, chair of the ACRIN PET Imaging Core Laboratory, co-chair of the NOPR working group, and professor of radiology and chief of Nuclear Medicine at the Mallinckrodt Institute of Radiology in St. Louis.
Studies published in the Journal of Clinical Oncology the Journal of Nuclear Medicine and Cancer analyzed data from more than 41,000 NOPR cases and found that results of PET scans led to an intended change in cancer management of nearly 40 percent of patients. Approximately 10 percent of all Medicare covered PET scans in 2007 were performed under the auspices of the NOPR.
“For a great many patients, who would otherwise have to pay out-of-pocket for their PET scans, this CMS decision will save thousands of dollars. It will also allow more providers to offer this life-saving care to our nation’s seniors,” stated R. Edward Coleman, member of the NOPR working group, former chair of the ACR Nuclear Medicine Guidelines and Standards Committee, and chief of Nuclear Medicine at Duke University Hospital.
The NOPR was launched in May 2006. The ACR and ACRIN worked to develop the NOPR in collaboration with registry sponsor, the Academy for Molecular Imaging since CMS announced its intent to support a PET registry in January 2005. The American Society of Clinical Oncology and the Society for Nuclear Medicine also have played key roles in guiding the project’s development.
FDG-PET, also called PET imaging or PET scan, is a test that images the function of cells to show differences between healthy tissue and diseased tissue. It uses a small amount of a radioactive chemical which is combined with sugar. This combination is called FDG, so the test is sometimes called an FDG-PET scan. It is used to evaluate various neurological and cardiac disorders, as well as for diagnosing, staging, and monitoring the treatment of many different cancers.