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Medicare pays for one FDG PET scan to plan the first treatment of most cancers, and for three more scans after the first treatment is finished; a local contractor decides on any further scans. A few uses are excluded, such as planning first treatment for prostate cancer.
United States, Medicare National Coverage Determination 220.6.17, version 4, effective for claims with dates of service on and after 11 June 2013, implemented 7 March 2014. At the request of the National Oncologic PET Registry, CMS ended the prospective data collection that coverage with evidence development (CED) had required for every oncologic use of FDG PET. The decision does not change coverage of PET with NaF-18, ammonia N-13 or rubidium-82.
Initial anti-tumour treatment strategy: CMS covers "one FDG PET study for beneficiaries who have cancers that are biopsy proven or strongly suspected" when the treating physician needs it to decide whether an invasive procedure is appropriate, where to do it, or the anatomic extent of the tumour. Subsequent strategy: "Three FDG PET scans are nationally covered when used to guide subsequent management of anti-tumor treatment strategy after completion of initial anti-cancer therapy"; coverage of more than three is left to the local Medicare Administrative Contractors.
The NCD's synopsis table covers both stages for colorectal, oesophageal, head and neck (not thyroid or CNS), lymphoma, non-small cell and small cell lung, ovary, brain, soft tissue sarcoma, pancreas, testes, thyroid, myeloma, all other solid tumours and all other cancers. The exceptions for initial strategy: prostate adenocarcinoma is non-covered; breast is non-covered for diagnosis and initial staging of axillary nodes but covered for staging distant metastasis; melanoma is non-covered for evaluating regional lymph nodes; cervix is non-covered for initial diagnosis but covered for staging newly diagnosed cancer after conventional imaging. Every cancer in the table, including prostate, is covered for subsequent strategy.
Showing the technology this term belongs to: FDG PET.
Shares Medicare coverage with evidence development, Centers for Medicare & Medicaid Services (CMS) and the tag us.
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Shares Centers for Medicare & Medicaid Services (CMS), Prostate cancer and the tag us.
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