June 27, 2013

New Guidelines for Oncological CMS Coverage of FDG-PET (PT/CT)

Effective June 11, 2013 CMS Will Cover Three (3) PT/CT Scans for All Clinical Indications Formerly Covered Under NOPR

CMS Coverage for Initial Treatment Strategy (ITS) – CMS will continue to cover an ITS FDG-PET (PT/CT) scan for beneficiaries when it is needed to determine anti-tumor strategy for the following reasons:

  • To determine appropriateness for beneficiary to receive an  invasive diagnostic or therapeutic procedure
  • To determine the location for an invasive procedure
  • To determine the extent of the tumor when the anti-tumor treatment is dependent on the extent of the tumor

CMS Coverage for Subsequent Treatment Strategy (STS) – CMS will cover FDG-PET (PT/CT) scans for beneficiaries when used for guiding subsequent management of anti-tumor treatment strategy.

  • Coverage of more than 3 FDG-PET (PT/CT) scans shall be determined by the local Medicare Administrative Contractors (MAC)

 For More Information Click Here!

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