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Medicare In Brief

This article was originally published in The Gray Sheet

Executive Summary

Comments on PET for solid tumors, myeloma: Physicians and specialty societies are urging CMS to reconsider Medicare policy that allows doctors to perform only one positron emission tomography scan when planning initial radiation treatment in patients with solid tumors or myeloma. "The current 'one scan' restriction precludes obtaining the specially aligned PET scan that is required for radiation treatment planning," says David Milstein, M.D., Albert Einstein College of Medicine. America's Health Insurance Plans, however, argues against additional PET scans without evidence that second tests are necessary to make treatment decisions and that those decisions improve health outcomes. The Academy of Molecular Imaging suggests "it is possible to extend coverage for certain limited radiation therapy purposes ... without allowing the exception to consume the rule." CMS opened its national coverage analysis in November and will issue a proposed decision by May 9, 2010 (1"The Gray Sheet" Nov. 16, 2009)

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