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Overview
The Centers for Medicare and Medicaid Services (CMS), as the Federal
agency that administers the Medicare program, currently pays for
positron emission tomography (PET) scans for only nine types of cancer.
CMS wants to determine if they should pay for PET scans for diagnosis,
staging, and treatment monitoring for more 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). For patients and referring physicians who
give permission, this information 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 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. Prior to 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. Many
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 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 are referred for a FDG-PET scan to
diagnose, stage, or monitor a cancer that is currently not reimbursable
(or specifically excluded) under Medicare 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 patientŐs Medigap
insurance.
How is a Patient Entered in the Registry?
The PET facility must be registered to participate in the NOPR and the
patientŐs 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 patientŐs planned
treatment. The PET facility will enter the patientŐs information into
the registry database through a secure web site.
Who Will Have Access to Patient Information?
The data submitted to the NOPR will be kept in a secure electronic
database managed by the American College of Radiology Imaging Network
(ACRIN) at the American College of Radiology (ACR). All data will also
be sent to CMS. This data will not be used for research purposes, but
must be sent to CMS as a condition for Medicare payment for the PET
scan.
Additionally, patients and referring physicians, can consent (or not) to
allow their data to be used for purposes of the research being conducted
at NOPR. The dataset used by NOPR investigators for research will
contain only the data of patients and physicians when both 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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