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Overview
The Centers for Medicare & Medicaid Services (CMS), as the Federal agency that administers the Medicare program, currently only pays for positron emission tomography (PET) scans for certain reasons and for certain types of cancer. CMS wants to determine if they should pay for PET scans for additional reasons and additional types of cancer. In order to collect the information needed to decide which other types of cancer should be covered by Medicare, CMS will provide payment for the PET scans of patients who are properly registered with the National Oncologic PET Registry (NOPR). Since May 2006, the NOPR has been collecting information about how the information obtained from PET with the radioactive tracer F-18 fluorodeoxyglucose (FDG) influences the referring doctor’s plan for treating the patient. In April 2009, in part based on data collected by the NOPR, CMS expanded coverage for PET with FDG, but required that the NOPR still needed to collect data for certain uses of this diagnostic imaging study.
In February 2010, CMS also determined that it would pay for PET scans done with sodium fluoride F-18 (NaF) in order to identify bone metastases when the patient is registered with the NOPR. The NOPR began collecting information on PET scans with NaF in January 2011.
Information provided by the treating physicians about their patients’ care will then be analyzed to determine the effect PET scans had on the way physicians planned to treat their patients.
What is FDG-PET?
Positron emission tomography (PET), also called PET imaging or PET scan, is a test that images the function of cells to show differences between healthy tissue and diseased tissue. It uses a small amount of a radioactive chemical which is combined with sugar. This combination is called F-18 fluorodeoxyglucose or FDG, so the test is sometimes called an FDG-PET scan. It is used to evaluate various neurological and cardiac disorders, as well as for diagnosing, staging and monitoring the treatment of many different cancers. To perform the PET scan, a small amount of FDG is injected into the patient. Because cancer grows at a faster rate than healthy tissue, cancer cells take up more of the FDG. The PET scanner detects the radiation given off by the FDG and produces color-coded pictures (images) of the body that show both normal and cancerous tissue. Most current PET scanners also include a conventional x-ray computed tomography (CT) scanner. This allows images of both anatomy (CT) and function (PET) to be taken during the same examination.
What is NaF-PET?
PET also can be perfomed with a small amount of the radioactive chemical known as sodium fluoride F-18 or NaF, This test is sometimes called an NaF-PET scan. NaF-PET is similar to the common nuclear medicine test known as a bone scan, the main difference being the use of a PET or PET/CT scanner to produce the images with NaF-PET. An NaF-PET scan shows the differences between healthy and diseased bone, and is especially helpful for detecting spread of cancer to bone. As with FDG-PET, most NaF-PET scans are performed on a PET/CT scanner, thus allowing images of both bone anatomy (CT) and bone function (PET) to be taken during the same examination.
What PET Scan Facilities Can Participate in the NOPR?
Any PET facility that is allowed to bill CMS can participate in the NOPR. PET facilities are charged a one-time $50 facility registration fee and $50 for each patient entered on the Registry.
What Patients are Eligible to Participate in the NOPR?
All Medicare beneficiaries who have Medicare as their primary insurance and are referred for a FDG-PET scan to evaluate a cancer that is currently not reimbursable (or specifically excluded) under Medicare are eligible to participate in the NOPR. Additionally, Medicare beneficiaries who are referred for an NaF-PET scan to evaluate proven or strongly suspected spread of cancer to bone are eligible to participate in the NOPR. Patients with insurance coverage other than Medicare (including those with Medicaid) are not eligible. Patients with managed Medicare health plans, such as Medicare Advantage, are eligible for the NOPR.
Who Will Pay for the PET Scans?
The PET scans will be paid by Medicare. Co-payment costs or deductible payments will be paid by the patient or by the patient’s Medicare Supplemental (Medigap) insurance
How is a Patient Entered in the Registry?
The PET facility must be registered to participate in the NOPR and the patient’s referring physician (medical oncologist, radiation therapist, surgeon, etc.) must agree to complete pre- and post-PET data collection forms that ask several questions regarding the patient’s planned treatment. The PET facility will enter the patient’s information into the registry database through a secure web site.
Who Will Have Access to Patient Information?
The PET facility must be registered to participate in the NOPR and the patient’s referring physician (medical oncologist, radiation therapist, surgeon, etc.) must agree to complete pre- and post-PET data collection forms that ask several questions regarding the patient’s planned treatment. The PET facility will enter the patient’s information into the registry database through a secure web site.
Additionally, patients will be asked at the time of the PET scan whether or not they consent to allow their data to be used for purposes of the research being conducted at NOPR. The referring physicians also asked to provide their consent for research use of the information, and for NaF-PET scans, the physicians who read the PET scans will also be asked to provide consent. The dataset used by NOPR investigators for research will contain only the data of patients and physicians when both (or all three in the case of NaF-PET) have consented to have the data included. Only members of the NOPR working group and NOPR project staff at ACRIN and the Center for Statistical Sciences at Brown University will have access to this individual patient data. These are the people who are responsible for making a recommendation to CMS on what types of PET scans should be paid for by Medicare. At no time will data that identifies individual patients be made public.
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