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PET policy

This article was originally published in The Gray Sheet

Executive Summary

CMS is considering whether it should alter its approach to coverage of positron emission tomography for cancer to make it more of an all-cancers-or-none strategy. The current framework requires consideration, on a cancer-by-cancer basis, of whether the technique is reasonable and necessary for diagnosis, staging, restaging and monitoring response to treatment, but the agency says it has received public input suggesting that an "omnibus" consideration might be better. The reassessment is part of CMS' ongoing process to consider whether evidence collection requirements established in 2005 as a condition for national coverage for use of PET in nine cancers are still necessary. The consideration has now been expanded to all solid tumors. In August, an advisory committee recommended that the data collection mandate was still needed (1"The Gray Sheet" Aug. 25, 2008, p. 15)
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