CMS Considers Request For Full Coverage of PET for All Types of Cancer
April 16, 2008
Physicians say that registry data support broad coverage.
CMS is considering a request to end the data collection requirements that have been a condition of coverage for PET scans used in diagnosing and staging a variety of types of cancer. The request was made by the physicians who have overseen the National Oncologic PET Registry which has been collecting data on brain, cervical, ovarian, pancreatic, small cell lung, and testicular cancers since CMS made it a condition of coverage for these conditions in 2005. 
Click to view the letter.
In making the request, the physicians said that data gathered by the registry over the past 18 months offer “strong empirical evidence” to provide unrestricted PET coverage for diagnosing, staging, and finding recurrence of virtually all types of cancer. The request cited data which showed the dramatic impact of PET scanning in helping physicians make care-management decisions. According to the request:
- PET is associated with a 36.5 percent change in physician decisions about whether or not to treat the cancer. In most of those cases, physicians switched from a non-treatment to a treatment plan because the PET scans showed more cancer or additional cancer sites.
- PET was associated with a much bigger change when a broader range of physician decision-making was taken into account. “PET was actually associated with a management change in almost three-quarters of patients when the addition or deletion to specific modes of therapy are included, and as well as alterations in the type of non-treatment care recommended.”
- The impact of PET on the management decisions was observed across the full spectrum of indications, said the request. “The clinical impact of PET appears to be even greater than the impact of body CT when it was introduced thirty years ago,” said the request
The request said that there is insufficient data from the registry at this time to support coverage of PET for treatment monitoring. “Therefore, we propose to continue using the [PET registry] to collect data on the value of PET for this purpose, and we will continue to analyze additional data over a longer period.”
CMS will take public comments through May 10, 2008. Click here to review the CMS tracking sheet on the coverage review.
Click here to view the letter requesting the coverage change.
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