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Medicare Expands Coverage of Diagnostic PET

Medicare Expands Coverage of Diagnostic PET

WASHINGTON—Medicare will begin or expand coverage of positron emission tomography (PET) diagnostic scans for several cancers on July 1. For the first time, Medicare will cover PET for head and neck cancers, except for central nervous system and thyroid cancers, and esophageal cancer. Coverage will apply to diagnosis, staging, and restaging.

Medicare is also expanding PET coverage for four other cancers. It will now cover diagnosis, staging, and restaging for non-small-cell lung cancer (NSCLC), colorectal cancer, and lymphoma. Previously, Medicare only included PET for the initial staging of NSCLC; determining the location of colorectal tumors if a rising CEA level suggested a recurrence; and the staging and restaging of lymphoma only when PET was used as an alternative to gallium scans.

In addition, Medicare will cover PET for the diagnosis, staging, and restaging of melanoma, but not for the evaluation of regional nodes. Previously it covered PET’s use to evaluate a melanoma recurrence prior to surgery as an alternative to a gallium scan.

To be eligible for Medicare payment, PET scans for these approved cancers must use the radiopharmaceutical 18F-fluorodeoxyglucose (FDG), which is administered intravenously.

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