CMS denies reimbursement for sodium fluoride PET scans

December 16, 2015

In a final decision memo released Dec. 15, CMS said it had determined that use of an NaF-18 PET scan to identify bone metastasis of cancer “is not reasonable and necessary to diagnose or treat an illness or injury or to improve the functioning of a malformed body member.”

The agency said it is awaiting evidence, published in a peer-reviewed journal, showing that NaF-18 PET imaging leads to a change in patient management to more appropriate palliative care, a change in patient management to more appropriate curative care, improved quality of life or improved survival. CMS will continue reimbursing for NaF-18 PET under coverage with evidence development (CED) programs for 24 months following the announcement of the decision.

...Dr. Gary Dillehay, past president of the Society of Nuclear Medicine and Molecular Imaging and professor of radiology at Northwestern University's Feinberg School of Medicine, said CMS is taking a closer look at new technology.

“Unfortunately, everything new in nuclear medicine has been expensive compared to what’s out there,” Dillehay told HCB News. “Being just as good as, or a little bit better, than the current technique is not going to work with CMS anymore.”

Read the full article.