Imaging groups urge CMS to reverse decision, cover NaF PET

Tests show the imaging technology is effective in gauging bone metastasis and indicating appropriate care.

Several radiological and imaging professional associations are asking the Centers for Medicare and Medicaid Services to reverse a decision and provide coverage for a specialized form of positron emission tomography imaging, saying it’s a key to monitoring patients and providing appropriate care.

The organizations contend that Medicare patients with metastatic cancers may be negatively impacted by the recent CMS decision to decline to provide coverage for 18F-sodium fluoride positron emission tomography (NaF PET) imaging.

Organizations supporting the coverage of the NaF PET imaging include The World Molecular Imaging Society, the American College of Radiology, the Society of Nuclear Medicine and Molecular Imaging and the members of the National Oncologic PET Registry (NOPR) Working Group. The associations are asking CMS to reconsider last month’s denial of a National Coverage Determination against NaF PET.

In the May ruling, CMS said that the evidence to support coverage for the imaging procedure was insufficient to overturn an initial decision to cease coverage for the procedures for Medicare beneficiaries. The ruling is frustrating to the organizations, because they cite evidence to suggest that NaF PET is effective.

In conjunction with the groups’ plea to CMS, the Journal of Nuclear Medicine published analyses requested by CMS that demonstrated the use of NaF PET for detection of bone metastasis leads to changes in patient management and more appropriate curative or palliative care across the continuum of care for patients with cancer.

"The NOPR data clearly show that use of NaF PET led to more appropriate care for many cancer patients,” says Bruce Hillner, MD, principal investigator for NOPR. “We urge CMS to reconsider coverage for these potentially life-saving and life-improving exams."

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In December 2017, the NOPR Working Group formally submitted a request to CMS for reconsideration of its denial of coverage for NaF PET. NOPR says CMS denied the coverage again, even though the findings of the NOPR research demonstrated that NaF PET results altered treatment plans and led to actual changes in care.

"We are disappointed that CMS did not open a reconsideration and allow public comment on the published evidence to support coverage for NaF PET. Many cancer patients would be helped by CMS reconsidering coverage for these exams," says Barry Siegel, MD, NOPR’s co-chair.

The professional organizations collaborated with CMS and NOPR to collect clinical utility data on NaF PET since 2011. During that time, the NOPR performed more than 65,000 scans for Medicare beneficiaries. The study ended in December, and Medicare coverage for it ended.

"Many seniors may ultimately receive care that is not as effective or helpful as it could be if CMS does not reconsider Medicare coverage for NaF PET. This is a step backwards in care for these patients. We urge CMS to reconsider coverage so that these seniors can have access to care that can better help them," said Anthony Shields, MD, NOPR’s co-chair.

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