Medicare to Add PET Coverage for Some Thyroid Cancer Patients

August 1, 2003

Medicare will grant limited coverage for the use of positronemissiontomography (PET) for certain of its beneficiariessuffering from thyroid cancer, the Centers for Medicare andMedicaid Services (CMS) recently announced. CMS also said that ithad refused a request to provide PET coverage for soft-tissue sarcomabecause imaging techniques currently covered by Medicare providegood diagnostic results.

Medicare will grant limited coverage for the use of positronemissiontomography (PET) for certain of its beneficiariessuffering from thyroid cancer, the Centers for Medicare andMedicaid Services (CMS) recently announced. CMS also said that ithad refused a request to provide PET coverage for soft-tissue sarcomabecause imaging techniques currently covered by Medicare providegood diagnostic results.In December 2000, Medicare granted broad approval for the use ofPET in head and neck cancers, but specifically excluded thyroid cancer.Six months later, it agreed to reexamine its decision at the requestof the American Thyroid Association, which provided new data tosupport its arguments. The agency said that "evidence is adequate toconclude that use of PET for staging of follicular cell thyroid cancerpreviously treated by thyroidectomy and radioiodine ablation, with anelevated or rising serum Tg [thyroglobulin] greater than 10 ng/mL andnegative I-131 whole-body scintigraphy, is reasonable and necessaryfor the diagnosis or treatment of the illness or injury or to improve thefunctioning of a malformed body member in the population specified."