February 28, 2016

Medicare CED for NaF-18 PET Extended Another 24 Months

Despite persuasive evidence to the contrary, the Centers for Medicare & Medicaid Services (CMS) announced Dec. 15, 2015 that it will continue its coverage with evidence development (CED) requirement for NaF-18 PET imaging of cancerous bone metastasis for another 24 months.

The requirement will give researchers more time to determine if NaF-18 PET changes patient management enough to contribute to more appropriate palliative or curative care and if it improves patient survival or quality of life, according to the agency. 

The CMS decision against a national coverage policy for routine Medicare reimbursement of NaF-18 PET for diagnosing bone metastases for all cancers runs contrary to affirmative recommendations from the American College of Radiology (ACR), Society of Nuclear Medicine and Molecular Imaging, and American College of Nuclear Medicine. 

The medical societies issued a joint comment letter to CMS Oct. 16 to agree with the National Oncologic PET Registry (NOPR) Working Group that published peer review research, submitted as part of an NOPR reconsideration request, was more than sufficient to demonstrate that NaF-18 PET is reasonable and necessary for clinically effective patient management. The reconsideration request was based on NOPR data comprising 35,468 NaF-18 PET scans performed on 27,713 patients at 1,000 health care facilities. 

CMS announced it will reconsider the national coverage determination (NCD) when sufficient evidence concerning the experimental application of NaF-18 PET for imaging bone metastases has been published in a peer-reviewed journal. The ACR expressed disappointment with the decision.