WASHINGTONMedicare 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
The decision covers the use of dedicated full circular ring PET
scanners and some partial ring systems for six types of cancerlung,
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
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
As an example, the agency cited its previous policy of covering
PET scans for only one narrow indication for colorectal cancerthe recurrence
of colon cancer as evidenced by a rising carcinoembryonic antigen level.