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Medicare Coverage In Brief

This article was originally published in The Gray Sheet

Executive Summary

No coverage for PET infection Dx: CMS will maintain its noncoverage policy for fluorodeoxyglucose-positron emission tomography (PET) scans to diagnose chronic osteomyelitis (bone infection), infection from hip arthroplasty and fevers of unknown origin, it said March 19. The agency cites inadequate data, "including heterogeneity of cases, lack of consistent comparators, small samples sizes, missing data ... and poor methodologic structure." CMS decided against employing a coverage-with-evidence-development policy because nobody proposed a clinical study that would fulfill the requirements, the agency said. CMS already covers PET for diagnosing certain cancers and conditionally covers PET for other indications, including Alzheimer's, dementia and other cancers

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