Radiology Coding Alert
Prepare for PET Changes That Could Be Coming Down the Pike
National Medicare may offer more leeway for local coverage.
You may see your PET local coverage determination getting an update in the near future.
CMS is considering allowing local MACs to determine coverage within their jurisdictions for oncologic PET imaging using pharmaceuticals, assuming there’s no national policy to override the local one.
In a proposed decision memo, dated Dec. 13, 2012, CMS specifies the local coverage will be for PET "using radiopharmaceuticals for their labeled indications for oncologic imaging that are approved by the U.S. Food and Drug Administration (FDA)."
What’s not affected? "This change would not apply to any use of PET using radiopharmaceuticals FDG (2-deoxy-2-[F-18] fluoro-D-Glucose (fluorodeoxyglucose)), NaF-18 (fluorine-18 labeled sodium fluoride), ammonia N-13, or rubidium Rb-82," the memo states.
The memo is online at www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=261.
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