HCFA Approves PET Scan Coverage for Specific Cancers

HCFA announced on Friday that it will cover the cost of positron emission tomography(PET) scans for diagnostic purposes in certain cancers, the Washington Post reports. Medicare will now cover the cost of the test, about $2,000 for each scan, to diagnosis recurrent lung, esophagus, colon and rectum, lymphoma, melanoma and mouth and throat cancers. Unlike CAT or MRI scans, PET scans are not only able to detect a tumor but also indicate whether the tumor is malignant. The coverage, which will take effect "no later than next July," could add "hundreds of millions" to the cost of Medicare, as the conditions covered are prevalent in people over 65 years old. Previously, Medicare had covered PET scans for only a few cancers where studies indicated the test had "benefit." After lobbying from the University of California at Los Angeles and 19 U.S. Senators, the agency agreed to expand its coverage. The university had sought PET coverage for 20 different cancers, as well as ischemic heart disease and Alzheimer's disease, but the agency stopped short of offering total coverage. In addition to approving PET scan use for six of the 20 recommended cancers, HCFA also approved use of the scan as a "backup diagnostic test in heart disease, and referred the Alzheimer's indication to an advisory committee for further study."

Proponents of expanded coverage said it was safe to "assume" PET scans would prove useful in all cancers, even though studies involving PET scans have been focused on "specific cancers." Harold Sox, chair of the Medicare Coverage Advisory Committee, said, "I think the folks at HCFA tried very hard to do this in the most scientifically sound way, under very pressuring time circumstances ... I think they did well" (Brown, Washington Post, 12/16). NIH's National Cancer Institute also had supported Medicare coverage for the procedure. Sens. Ted Stevens (R-Alaska) and Bill Frist (R-Tenn.), who sponsored legislation several years ago to provide PET coverage under Medicare, have also served as "big advocates" of PET scans. The Post reported last month that Stevens is a close friend of Michael Phelps, the UCLA chemist who "invented the technology in the early 1970s," and that a "worldwide supplier of PET scanners," CTI, Inc., is headquartered in Frist's home state of Tennessee (American Health Line, 11/7).