The Centers for Medicare and Medicaid Services (CMS) released its proposed decision to remove the national coverage determination (NCD) 220.6.20, ending coverage with evidence development (CED) for positron emission tomography (PET) beta-amyloid imaging, and permitting Medicare coverage determinations for PET beta-amyloid imaging to be made by the Medicare Administrative Contractors (MACs).
Since Sept. 27, 2013, CMS has covered Beta Amyloid PET imaging under CED. The American College of Radiology® (ACR®) worked with CMS over the last decade to generate the evidence necessary to expand coverage and access to this critical diagnostic tool for patients suffering from cognitive decline. In comments submitted to CMS in February and July 2022, the College strongly urged CMS to expand access to gold-standard diagnostic imaging for populations most at risk for Alzheimer’s disease. As a result of our efforts, CMS proposes to remove the NCD for beta-amyloid PET, which would allow local MACs to make coverage determinations regarding the use of Beta Amyloid PET imaging to include covering more than one scan per patient’s lifetime, and use within or outside the context of a CMS-approved study.
ACR applauds CMS for going beyond and using the initial public comments to inform its proposed decision to remove the CED requirement entirely. The College believes the evidence is sufficient to end the CED and allow national coverage of beta-amyloid PET. CED enables providers and suppliers to perform high-quality studies that will produce evidence that may lead to positive national coverage determinations.
ACR will continue to track and monitor policy developments on this clinical topic and will submit comments to CMS regarding this proposed coverage decision. The College encourages members to also submit comments electronically by Aug.16.
If you have questions regarding NCDs, contact Alicia Blakey, ACR Principal Economic Policy Analyst.