June 14, 2018

CMS Refuses Medicare Coverage of NaF PET Scans

The American College of Radiology (ACR) has joined the World Molecular Imaging Society (WMIS), the Society of Nuclear Medicine and Molecular Imaging (SNMMI), and members of the National Oncologic PET Registry (NOPR) Working Group in a public expression of disappointment with a recent decision by the Centers for Medicare & Medicaid Services (CMS) to deny their request to open a reconsideration of the National Coverage Determination (NCD) for 18F-sodium fluoride positron emission tomography (NaF PET), a potentially lifesaving cancer imaging procedure.

At the request of CMS, the Journal of Nuclear Medicine published analyses demonstrating that NaF PET for detecting bone metastasis leads to changes in patient management and more appropriate curative or palliative care than alternative imaging techniques across the continuum of care for cancer patients. In December 2017, the NOPR Working Group formally submitted a request to CMS for reconsideration of the NCD for NaF PET.

The response letter from CMS indicated that the evidence included in the reconsideration request letter was “insufficient to support a reconsideration as it would not change the current NCD”.

WMIS, ACR and SNMMI have collaborated with CMS and the NOPR to collect clinical utility data on NaF PET since 2011. During that time, the NOPR performed over 65,000 scans of Medicare beneficiaries. With the closure of the NOPR to patient accrual in December 2017, this vital imaging service is no longer covered for Medicare beneficiaries.

The ACR will continue to work with fellow advocates of clinically effective PET applications in oncology to gain coverage for NaF PET. For more information, please contact Katie Keysor at kkeysor@acr.org.