Medicare to Cover PET Scans for Six Types of Cancer

WASHINGTON—Medicare will soon cover or expand its coverage of the use of positron emission tomography (PET) for the primary diagnosis, staging, or restaging of six types of cancer. The Health Care Financing Administration (HCFA) said it would announce an effective coverage date shortly.

The decision covers the use of dedicated full circular ring PET scanners and some partial ring systems for six types of cancer—lung, colorectal, lymphoma, melanoma, esophageal, and head and neck.

HCFA said it will refer the question of PET reimbursement for breast cancer to the Medicare Coverage Advisory Committee, a panel of experts from outside of government that advises the agency on coverage issues.

HCFA’s decision followed a petition filed last summer by UCLA requesting that Medicare cover use of PET in diagnosing 20 types of cancer as well as cardiac and neurologic applications. HCFA then began an evaluation to determine whether current scientific evidence supports the use of PET scans as a "reasonable and necessary" diagnostic procedure for the applications.

The 14 cancers not included in the new decision, including brain and thyroid cancer, will remain uncovered. However, HCFA invited formal requests for new or broader PET coverage for specific cancers.

Until now, Medicare covered only specific uses of PET, such as the localization of a recurrence for a cancer. The new policy provides coverage for all clinically appropriate uses of PET for six cancer types. This means broader coverage for four previously covered cancers and new coverage for two others.

As an example, the agency cited its previous policy of covering PET scans for only one narrow indication for colorectal cancer—the recurrence of colon cancer as evidenced by a rising carcinoembryonic antigen level.