There has been a lot of buzz around the new scanning contrasts that have come into limited usage for evaluating metastasized cancer cells that are in the bones. Despite the enthusiasm from the prostate and breast cancer communities, CMS (Medicare) continues to limit its financial coverage for PET scans using the contrast NaF-18 even though it has displayed an increased ability to detect bone metastases.
In the past CMS, had been willing to pay for positron emission tomography or NaF-18 PET scans as long as physicians collected and reported the data on its use and put it into a clinical registry. In a recent comment CMS claimed, “the data shows that PET scans to find metastasized cancer cells in bones are not reasonable and necessary to diagnose or treat an illness or injury.” Or simply, using the contrast and spending the financial resources is unnecessary.
This opinion has received a level of support from the American Society of Clinical Oncology (ASCO) who has placed excessive use of PET, along with other expensive diagnostic imaging tests, such as CT and MRI tests, on its ‘Choosing Wisely’ list of technologies to consider carefully before deploying.” ASCO, and I concur, “now recommends against using imaging tests for low-risk, early stage breast cancer and prostate cancer.”
Medscape (12/17, Ault, 258K) reports that the CMS, has “said it would continue to cover the NaF-18 PET scan procedure for 2 years for patients enrolled in clinical trials, as part of its coverage with evidence development process,” and it “will reconsider national coverage in 2017.” Medscape adds that the CMS “seemed almost miffed at the lack of evidence it found in reviewing the last 5 years’ worth of data.” The agency wrote, “we are perplexed why additional analyses were not performed and published to confirm actual changes in patient management that improves health outcomes occurred.”
This means that those of us who desire the NaF-18 PET scans will either continue to self-pay or need to be a part of a clinical trial.