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Medicare proposes wider cancer scan coverage
January 7, 2009 / 12:14 AM / 9 years ago

Medicare proposes wider cancer scan coverage

WASHINGTON (Reuters) - U.S. health officials proposed paying for wider use of PET scans to help doctors decide the initial course of treatment in some cancer patients, the Centers for Medicare & Medicaid Services said on Tuesday.

CMS currently allows the scans for cancer patients enrolled in Medicare but requires doctors and patients to enroll in a special registry, which some doctors and industry representatives maintain limits their use.

In a draft proposal, the agency said it would partially lift such requirements and allow most Medicare patients to undergo one positron emission tomography (PET) scan, though the changes would not apply to breast cancer, prostate cancer and melanoma.

Medicare provides health insurance for 44 million elderly or disabled patients, and its looser reimbursement policy -- if finalized -- is likely to boost PET scan makers such as General Electric Co, Siemens AG and Philips Electronics NV.

Under the proposal, patients could undergo one scan without registering but would have to enroll for future scans, making it easier for doctors to order the initial scan.

Last year a panel of outside experts expressed skepticism that information from such scans could help physicians make better decisions about how to treat cancer or benefit patients.

But doctors representing several industry and medical groups said current data supported wider use of the tests for a variety of cancers.

CMS said there was not enough evidence to support the scan in prostate cancer. The agency also did not review data on breast cancer and melanoma and said the proposal did not apply in those cases.

More than 2 million PET scans are given in the United States each year, and administering them can cost between $2,500 and $6,000 each time, according to industry statistics.

But scientists have raised questions about how well PET scans can detect cancer cells compared to other imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) scans.

Patients undergoing PET receive injections of radioactive sugars that collect in metabolically active parts of the body and could signal cancer. While PET can find some cancers that CT and MRI miss, its images can be less detailed or trigger false positives.

CMS is accepting public comments on the proposal until February 5 and plans to issue a final decision in April. It posted its draft report on its website here

Editing by Carol Bishopric

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