AMA Clinical Examples in Radiology - 2016 Bulletin 1
Medicare CED for NaF-18 PET Extended
Medicare CED for NaF-18 PET Extended Despite persuasive evidence to the contrary, the Centers for Medicare and Medicaid Services (CMS) will continue its coverage with evidence development (CED) requirement for NaF-18 positron emission tomography (PET) imaging of cancerous bone metastasis through 2018. CMS noted that the CED requirement will give researchers more time to determine if NaF-18 PET changes patient management enough to contribute to more appropriate palliative or curative care and if it improves patient survival or quality of life, according to the agency. The CMS decision ( www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=279 ) against a national coverage...
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Article Overview
This article summarizes a CMS decision affecting Medicare coverage policy for NaF-18 PET imaging and explains why the issue remains under coverage with evidence development. It is relevant to radiology, nuclear medicine, oncology, and medical coders tracking Medicare policy changes, professional society comments, and the broader evidence base supporting national coverage review.
Why This Topic Matters
Coverage policy changes can affect reimbursement, documentation expectations, and the pace at which new imaging services are adopted in practice. This update helps readers understand the current Medicare status, the organizations involved, and the fact that additional published evidence is still being awaited.
What You Will Learn
- How CMS addressed Medicare coverage for NaF-18 PET imaging
- Why coverage with evidence development remains in place
- Which professional and registry organizations were involved in the coverage discussion
- What type of additional evidence CMS said it wants before reconsidering coverage
Who Should Read This
- Radiology coders
- Nuclear medicine professionals
- Oncology practices
- Hospital and outpatient billing staff
- Compliance and reimbursement teams
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