tci Medicare Compliance & Reimbursement - 2004 Issue 25

HOSPITALS: CMS Finally Agrees To Cover PET Scans

Experts remain lukewarm on the new coverage. After numerous requests to reconsider its previous non-coverage decision, the Centers for Medicare & Medicaid Services revisited the evidence -- and officially changed its tune about coverage of positron emission tomography for beneficiaries suspected to have Alzheimer's disease. According to a CMS release, the June 15 draft decision comes after an "exhaustive review" of evidence tipped the scales in favor of coverage for PET scans used to diagnose AD in cases where diagnosis remains uncertain despite a thorough clinical evaluation. CMS' chief medical officer Dr. Sean Tunis says CMS plans to allow...

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