Medicare Compliance & Reimbursement
WINS, LOSSES AND TIES IN MEDICARE PET SCAN POLICIES
Health care providers will soon be able to bill Medicare for positron emission tomography scans for a wider range of conditions. But the expansion of PET scan coverage wasn't as extensive as some had hoped. That's the upshot of a quartet of coverage decision memoranda the Centers for Medicare & Medicaid Services issued April 16 (CAG#00095N, CAG#00099N, CAG#00088N, CAG#00165N). In the memos, CMS says it plans to expand PET coverage to beneficiaries with thyroid cancer (in certain circumstances) and with potential cardiac diseases (in particular, Medicare will cover the use of N-13 ammonia PET for the evaluation of myocardial perfusion). However, the agency decided against extending coverage for the use of PET scans for soft tissue sarcoma. The agency maintains that currently covered imaging techniques provide adequate diagnostic capabilities. CMS also ruled out covering PET for Alzheimer's disease and suspected dementia - but appears willing to change its mind on the subject. The agency says it's convening an expert panel to further explore the value of PET for Alzheimer's patients. As for dementia, CMS is ramping up a demonstration project to "evaluate the appropriate role of PET in patients with suspected dementia." To see the decision memos, go to http://cms.hhs.gov/coverage/8g.asp.
According to CMS, PET is now covered for staging and restaging of various cancers (including lung, esophageal, colorectal, lympheme, head and neck, and breast), myocardial viability and pre-surgery evaluation of refractory seizures.
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