CMS may not pay for certain PET scans starting March 2010

CMS wants to stop paying for positron emission tomography (PET) scans to diagnose cancer that has spread to the bones, according to a Nov. 30 memo.

The agency memo cited insufficient evidence to show diagnosis of bone metastases by PET imaging improves health outcomes of cancer patients. Based on this information, CMS claims that the diagnostic test is not reasonable or necessary.

However, the memo outlined several instances in which PET imaging would be covered, including to inform or guide antitumor treatment strategy and for patients enrolled in certain clinical trials.

CMS is soliciting public comment on the proposed decision through December 30, 2009. The decision should be finalized by February 28, 2010.

To learn more:
- view the CMS memo
- read the BNA story (subscription required)