CMS to Cover
PET Scans for
the Majority of
Medicare Cancer Patients
PET Scans for
the Majority of
Medicare Cancer Patients
NOPR Data Enables CMS to Cover PET Scans for the Majority of Medicare Cancer Patients
April 06, 2009
Philadelphia - The American College of Radiology (ACR) strongly supports the Centers for Medicare and Medicaid Services' determination to significantly expand coverage of positron emission tomography (PET) scans performed in both the initial and subsequent evaluation of patients with many types of cancer. The CMS move is based on significant clinical evidence regarding the effectiveness of PET for management of patients with cancer gleaned from the National Oncologic PET Registry (NOPR) which is co-managed by the ACR and ACRIN.
"Expanded CMS coverage for PET is a tremendous step forward for cancer care in this country. The NOPR is a shining example of how the medical community can interact with government on research that can ultimately save and extend patients' lives," said James H. Thrall, M.D., FACR, chair of the ACR Board of Chancellors, Radiologist-in-Chief, Massachusetts General Hospital, and Professor of Radiology, Harvard Medical School.
PET scans for many cancers were previously reimbursed only if the facility submitted data to the NOPR registry. Now, Medicare patients with essentially all cancers can receive Medicare coverage for at least one PET scan prescribed by their physicians for initial treatment strategy evaluation. In addition, PET is also now covered for 11 cancer types for subsequent treatment strategy evaluation. These cancers are breast, cervix, colorectal, esophageal, head and neck, lymphoma, melanoma, non-small cell lung, thyroid, myeloma and ovary. Patients with these cancers represent the vast majority of cancer patients in the Medicare system. For all other cancers, PET coverage for subsequent treatment strategy evaluation requires participation in an approved Coverage with Evidence Development (CED) program. The NOPR can, with planned modifications, continue to serve this function for those PET studies still requiring CED.
"NOPR data undoubtedly served a primary role in this CMS decision, which will allow seniors far greater access to PET imaging to guide their care. The registry provided undeniable evidence that PET scans can serve a vital role in diagnosing, staging, restaging and monitoring treatment for patients with many types of cancer. We are proud that NOPR efforts have enabled CMS take this very important step to help cancer patients nationwide," said Barry Siegel, M.D., FACR, chair of the ACRIN PET Imaging Core Laboratory, co-chair of the NOPR working group, and professor of radiology and chief of Nuclear Medicine at the Mallinckrodt Institute of Radiology in St. Louis.
Studies published in the Journal of Clinical Oncology the Journal of Nuclear Medicine and Cancer analyzed data from more than 41,000 NOPR cases and found that results of PET scans led to an intended change in cancer management of nearly 40 percent of patients. Approximately 10 percent of all Medicare covered PET scans in 2007 were performed under the auspices of the NOPR.
"For a great many patients, who would otherwise have to pay out-of-pocket for their PET scans, this CMS decision will save thousands of dollars. It will also allow more providers to offer this life-saving care to our nation's seniors," stated R. Edward Coleman, M.D., member of the NOPR working group, former chair of the ACR Nuclear Medicine Guidelines and Standards Committee, and chief of Nuclear Medicine at Duke University Hospital.
The NOPR was launched in May 2006. The ACR and ACRIN worked to develop the NOPR in collaboration with registry sponsor, the Academy for Molecular Imaging since CMS announced its intent to support a PET registry in January 2005. The American Society of Clinical Oncology and the Society for Nuclear Medicine also have played key roles in guiding the project's development.
FDG-PET, also called PET imaging or PET scan, is a test that images the function of cells to show differences between healthy tissue and diseased tissue. It uses a small amount of a radioactive chemical which is combined with sugar. This combination is called FDG, so the test is sometimes called an FDG-PET scan. It is used to evaluate various neurological and cardiac disorders, as well as for diagnosing, staging, and monitoring the treatment of many different cancers.
For more information about the NOPR please visit www.cancerpetregistry.org.
For more information about positron emission tomography (PET), please visit www.radiologyinfo.org.
The ACR is a national, professional organization serving nearly 33,000 radiologists, radiation oncologists, interventional radiologists, nuclear medicine physicians, and medical physicists with programs focusing on the practice of radiology and the delivery of comprehensive health care services.
Source: ACR
SNM Calls CMS PET Scan Decision a Major Benefit for Cancer Patients
National Oncologic PET Registry Provided Overwhelming Evidence of PET's Value
Reston, Va.-SNM applauds today's (4/6/09) decision by the Centers for Medicare and Medicaid Services (CMS) to expand coverage of positron emission tomography (PET) scans in the initial treatment strategy of patients with cancer. This decision was based, in large part, on compelling clinical evidence of the effectiveness of PET for cancer management and treatment contained in a comprehensive study known as the National Oncologic PET Registry (NOPR).
"This is a major victory for patients," said Robert W. Atcher, Ph.D., M.B.A., president of SNM and University of New Mexico/Los Alamos National Laboratory professor of pharmacy. "CMS' decision to cover PET scans for cancer demonstrates the intrinsic medical value of PET and important role of these scans in diagnosing, staging, restaging and monitoring treatment for many cancers."
Previously, PET scans for many cancers would be reimbursed only if the PET facility submitted data to the NOPR. Now, all Medicare beneficiaries with certain cancers will be able to receive Medicare coverage for at least one PET scan, as prescribed by their physicians. The nine currently covered cancers- breast, cervix, colorectal, esophageal, head and neck, lymphoma, melanoma, non-small cell lung and thyroid-have all been expanded to cover the subsequent treatment strategy, in addition to initial diagnosis. Additionally, Medicare is now expanding coverage to include ovarian cancer and myeloma, making a total of eleven indications now covered for both the initial diagnosis and subsequent treatment strategy for patients. For all other cancers, PET coverage for subsequent treatment strategy evaluation requires participation in an approved Coverage with Evidence Development (CED) program, such as a modified NOPR.
The new CMS decision will save patients thousands of dollars who would otherwise have to pay out-of-pocket for their PET scans. Additionally, this decision increases the likelihood that private insurers will eventually follow CMS' lead.
"For years, physicians and researchers around the world have known that PET is an invaluable diagnostic tool for guiding management of patients with a wide range of cancers," said Barry Siegel, M.D., co-chair of the NOPR Working Group and chief of the nuclear medicine at the Mallinckrodt Institute of Radiology, St. Louis, Mo. "The evidence contained in the NOPR study proves the effectiveness of PET as an essential part of a cancer patient's treatment planning."
To help PET providers better understand the repercussions of the new CMS policy and navigate the new NOPR system effectively, SNM will host a live audio conference, Monday, April 27, 1 p.m. to 2:30 p.m. EDT. For more information or to register for the audio conference, visit www.snm.org/PETChanges.
SNM's Atcher also noted that the organization will continue to work with partner medical and professional organizations to seek coverage for other types of cancers for which PET has a proven medical and therapeutic value. "Our goal is to continue to work tirelessly on behalf of our patients to ensure that all individuals whom physicians believe would benefit from these advanced imaging procedures receive the coverage they need for care," Atcher added.
NOPR was established in 2006 to track the utility of PET in patients with cancer. Studies, which analyzed data from more than 41,000 patients and were published in the Journal of Clinical Oncology and Journal of Nuclear Medicine, showed that the use of PET scanning led to an intended change in cancer management in more than one out of three cases.
NOPR is sponsored by the Academy of Molecular Imaging (AMI) and managed by the American College of Radiology (ACR) and ACR Imaging Network (ACRIN). The registry received input from-and is endorsed by-ACR, the American Society for Clinical Oncology (ASCO) and SNM. The NOPR Working Group was chaired by Bruce Hillner, M.D., of Virginia Commonwealth University and co-chaired by Barry Siegel, M.D., Washington University; R. Edward Coleman, M.D., Duke University; and Anthony Shields, M.D., Wayne State University.
Members of the press should contact Amy Shaw at (703) 652-6773 or ashaw@snm.org or Kathryn Wiley at (703) 326-1184 or kwiley@snm.org for more information or to schedule an interview with SNM leadership.
About SNM
SNM is an international scientific and medical organization dedicated to raising public awareness about what molecular imaging is and how it can help provide patients with the best health care possible. SNM members specialize in molecular imaging, a vital element of today's medical practice that adds an additional dimension to diagnosis, changing the way common and devastating diseases are understood and treated.
SNM's more than 17,000 members set the standard for molecular imaging and nuclear medicine practice by creating guidelines, sharing information through journals and meetings and leading advocacy on key issues that affect molecular imaging and therapy research and practice. For more information, visit www.snm.org.
Source: SNM
More information about the types of cancer covered by this new policy is available in CMS' final decision memorandum. Read the final decision on the CMS Web site at http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=218.
"Expanded CMS coverage for PET is a tremendous step forward for cancer care in this country. The NOPR is a shining example of how the medical community can interact with government on research that can ultimately save and extend patients' lives," said James H. Thrall, M.D., FACR, chair of the ACR Board of Chancellors, Radiologist-in-Chief, Massachusetts General Hospital, and Professor of Radiology, Harvard Medical School.
PET scans for many cancers were previously reimbursed only if the facility submitted data to the NOPR registry. Now, Medicare patients with essentially all cancers can receive Medicare coverage for at least one PET scan prescribed by their physicians for initial treatment strategy evaluation. In addition, PET is also now covered for 11 cancer types for subsequent treatment strategy evaluation. These cancers are breast, cervix, colorectal, esophageal, head and neck, lymphoma, melanoma, non-small cell lung, thyroid, myeloma and ovary. Patients with these cancers represent the vast majority of cancer patients in the Medicare system. For all other cancers, PET coverage for subsequent treatment strategy evaluation requires participation in an approved Coverage with Evidence Development (CED) program. The NOPR can, with planned modifications, continue to serve this function for those PET studies still requiring CED.
"NOPR data undoubtedly served a primary role in this CMS decision, which will allow seniors far greater access to PET imaging to guide their care. The registry provided undeniable evidence that PET scans can serve a vital role in diagnosing, staging, restaging and monitoring treatment for patients with many types of cancer. We are proud that NOPR efforts have enabled CMS take this very important step to help cancer patients nationwide," said Barry Siegel, M.D., FACR, chair of the ACRIN PET Imaging Core Laboratory, co-chair of the NOPR working group, and professor of radiology and chief of Nuclear Medicine at the Mallinckrodt Institute of Radiology in St. Louis.
Studies published in the Journal of Clinical Oncology the Journal of Nuclear Medicine and Cancer analyzed data from more than 41,000 NOPR cases and found that results of PET scans led to an intended change in cancer management of nearly 40 percent of patients. Approximately 10 percent of all Medicare covered PET scans in 2007 were performed under the auspices of the NOPR.
"For a great many patients, who would otherwise have to pay out-of-pocket for their PET scans, this CMS decision will save thousands of dollars. It will also allow more providers to offer this life-saving care to our nation's seniors," stated R. Edward Coleman, M.D., member of the NOPR working group, former chair of the ACR Nuclear Medicine Guidelines and Standards Committee, and chief of Nuclear Medicine at Duke University Hospital.
The NOPR was launched in May 2006. The ACR and ACRIN worked to develop the NOPR in collaboration with registry sponsor, the Academy for Molecular Imaging since CMS announced its intent to support a PET registry in January 2005. The American Society of Clinical Oncology and the Society for Nuclear Medicine also have played key roles in guiding the project's development.
FDG-PET, also called PET imaging or PET scan, is a test that images the function of cells to show differences between healthy tissue and diseased tissue. It uses a small amount of a radioactive chemical which is combined with sugar. This combination is called FDG, so the test is sometimes called an FDG-PET scan. It is used to evaluate various neurological and cardiac disorders, as well as for diagnosing, staging, and monitoring the treatment of many different cancers.
For more information about the NOPR please visit www.cancerpetregistry.org.
For more information about positron emission tomography (PET), please visit www.radiologyinfo.org.
The ACR is a national, professional organization serving nearly 33,000 radiologists, radiation oncologists, interventional radiologists, nuclear medicine physicians, and medical physicists with programs focusing on the practice of radiology and the delivery of comprehensive health care services.
Source: ACR
SNM Calls CMS PET Scan Decision a Major Benefit for Cancer Patients
National Oncologic PET Registry Provided Overwhelming Evidence of PET's Value
Reston, Va.-SNM applauds today's (4/6/09) decision by the Centers for Medicare and Medicaid Services (CMS) to expand coverage of positron emission tomography (PET) scans in the initial treatment strategy of patients with cancer. This decision was based, in large part, on compelling clinical evidence of the effectiveness of PET for cancer management and treatment contained in a comprehensive study known as the National Oncologic PET Registry (NOPR).
"This is a major victory for patients," said Robert W. Atcher, Ph.D., M.B.A., president of SNM and University of New Mexico/Los Alamos National Laboratory professor of pharmacy. "CMS' decision to cover PET scans for cancer demonstrates the intrinsic medical value of PET and important role of these scans in diagnosing, staging, restaging and monitoring treatment for many cancers."
Previously, PET scans for many cancers would be reimbursed only if the PET facility submitted data to the NOPR. Now, all Medicare beneficiaries with certain cancers will be able to receive Medicare coverage for at least one PET scan, as prescribed by their physicians. The nine currently covered cancers- breast, cervix, colorectal, esophageal, head and neck, lymphoma, melanoma, non-small cell lung and thyroid-have all been expanded to cover the subsequent treatment strategy, in addition to initial diagnosis. Additionally, Medicare is now expanding coverage to include ovarian cancer and myeloma, making a total of eleven indications now covered for both the initial diagnosis and subsequent treatment strategy for patients. For all other cancers, PET coverage for subsequent treatment strategy evaluation requires participation in an approved Coverage with Evidence Development (CED) program, such as a modified NOPR.
The new CMS decision will save patients thousands of dollars who would otherwise have to pay out-of-pocket for their PET scans. Additionally, this decision increases the likelihood that private insurers will eventually follow CMS' lead.
"For years, physicians and researchers around the world have known that PET is an invaluable diagnostic tool for guiding management of patients with a wide range of cancers," said Barry Siegel, M.D., co-chair of the NOPR Working Group and chief of the nuclear medicine at the Mallinckrodt Institute of Radiology, St. Louis, Mo. "The evidence contained in the NOPR study proves the effectiveness of PET as an essential part of a cancer patient's treatment planning."
To help PET providers better understand the repercussions of the new CMS policy and navigate the new NOPR system effectively, SNM will host a live audio conference, Monday, April 27, 1 p.m. to 2:30 p.m. EDT. For more information or to register for the audio conference, visit www.snm.org/PETChanges.
SNM's Atcher also noted that the organization will continue to work with partner medical and professional organizations to seek coverage for other types of cancers for which PET has a proven medical and therapeutic value. "Our goal is to continue to work tirelessly on behalf of our patients to ensure that all individuals whom physicians believe would benefit from these advanced imaging procedures receive the coverage they need for care," Atcher added.
NOPR was established in 2006 to track the utility of PET in patients with cancer. Studies, which analyzed data from more than 41,000 patients and were published in the Journal of Clinical Oncology and Journal of Nuclear Medicine, showed that the use of PET scanning led to an intended change in cancer management in more than one out of three cases.
NOPR is sponsored by the Academy of Molecular Imaging (AMI) and managed by the American College of Radiology (ACR) and ACR Imaging Network (ACRIN). The registry received input from-and is endorsed by-ACR, the American Society for Clinical Oncology (ASCO) and SNM. The NOPR Working Group was chaired by Bruce Hillner, M.D., of Virginia Commonwealth University and co-chaired by Barry Siegel, M.D., Washington University; R. Edward Coleman, M.D., Duke University; and Anthony Shields, M.D., Wayne State University.
Members of the press should contact Amy Shaw at (703) 652-6773 or ashaw@snm.org or Kathryn Wiley at (703) 326-1184 or kwiley@snm.org for more information or to schedule an interview with SNM leadership.
About SNM
SNM is an international scientific and medical organization dedicated to raising public awareness about what molecular imaging is and how it can help provide patients with the best health care possible. SNM members specialize in molecular imaging, a vital element of today's medical practice that adds an additional dimension to diagnosis, changing the way common and devastating diseases are understood and treated.
SNM's more than 17,000 members set the standard for molecular imaging and nuclear medicine practice by creating guidelines, sharing information through journals and meetings and leading advocacy on key issues that affect molecular imaging and therapy research and practice. For more information, visit www.snm.org.
Source: SNM
More information about the types of cancer covered by this new policy is available in CMS' final decision memorandum. Read the final decision on the CMS Web site at http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=218.