October 17, 2017
On December 15, 2015, The Centers for Medicare & Medicaid Services (CMS) issued a final decision memorandum http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=279 pertaining to the coverage of bone PET with F-18 sodium fluoride (NaF-PET) to identify bone metastasis. This National Coverage Decision (NCD) extended the requirement for coverage with evidence development (CED) under §1862(a)(1)(E) of the Social Security Act for NaF-18 PET to identify bone metastasis of cancer contained in section 220.6.19B of the Medicare National Coverage Determinations Manual for 24 months. The current NCD and Medicare coverage for NaF-PET (under CED) is due to expire on December 14, 2017 at midnight EST.
The NOPR Working Group has submitted a request to CMS asking that coverage for NaF-PET be reconsidered in light of the additional analyses of NOPR data along with Medicare claims data. A coverage decision in response to this reconsideration request is dependent on the publication in peer-reviewed journals of these additional analyses, and the timing of the coverage decision is currently unknown. However, it is highly unlikely that CMS will issue a coverage decision before the expiration of the coverage under the current NCD.
Accordingly, at midnight EST, December 14, 2017 the NOPR web site will no longer allow new case registrations. Additionally, all planned NOPR-covered NaF-PET studies must have been performed (and the PET Completion Form entered into the database) no later than December 14, 2017 at midnight EST. For any study performed on or before that date, entry of the PET Report Submission Form, the PET Scan Assessment Form, and the Post-PET Case Report Form will be allowed (within the time limits specified in the protocol). Participating sites should not schedule NaF-PET studies to be performed for Medicare patients after December 14, 2017, until a new NCD is issued by CMS.
At the closeout of NOPR (NaF-PET), the balances in individual PET facility escrow accounts will be refunded. However, to insure that funds are refunded properly, each PET facility must submit a refund request to the following: OPTOUT_NOPR@acr.org.
Please ensure that the request includes the following information:
NOPR will acknowledge receipt of your request and send a refund check payable to NOPR Facility indicated in the request.