HCFA expands Medicare reimbursement for PET
Positron emission tomography (PET) advocates, equipment manufacturers and suppliers received very welcome news from the Health Care Financing Administration (HCFA) on Dec. 15.

The agency issued a decision to expand Medicare reimbursement for PET scans for older Americans in six cancers — lung, colorectal, lymphoma, melanoma, head and neck and esophageal. In each of these cases, PET will be reimbursed from diagnosis and staging to assessment of therapy and the recurrence of disease.

The additional coverage will include FDG (fluorodeoxyglucose) cardiac scans for the evaluation of myocardial viability and neurological scans for the presurgical evaluation of patients with epilepsy.

According to the Academy of Molecular Imaging (Washington, D.C.), HCFA’s action marks the first time the agency has set a national coverage policy that allows physicians to use their judgment of how best to use PET to improve the care of their patients. The coverage also provides for determining which patients will benefit from revascularization in heart disease and for identifying epilepsy patients who will benefit from surgery.

PET certainly has caught the eye of medical imaging manufacturers over the last two years, as HCFA has begun to approve more indications for reimbursement. The PET market began to accelerate by mid-1998, as HCFA in January of that year cleared payments for PET imaging to detect solitary nodules and initial staging of diagnostic lung cancer. Reimbursement for additional indications have buoyed the PET market even further.

The industry consensus is that PET equipment sales could top $500 million worldwide in the next 12 to 18 months.

“That’s what happens when an industry sees PET as a powerful tool that can save lives,” said Beth Klein, vice president and global general manager for nuclear medicine and PET for GE Medical Systems (Waukesha, Wis.), speaking with Medical Imaging at the meeting of the Radiological Society of North America (RSNA) in November.

“PET is the most specific and sensitive device for detecting cancer,” she added. “You can detect lesions earlier with PET; sometimes before they can be seen anatomically. The earlier you detect lesions, the higher that correlates to saving lives.”

Klein said that PET sales now account for approximately 50 percent of GEMS’ nuclear medicine revenues.

“So many of the [industry] meetings over the past year have showcased PET,” Randy Weatherhead, vice president of nuclear sales and marketing for Siemens Medical Systems Inc. (Iselin, N.J.), told Medical Imaging at RSNA. “The technique is so powerful for showing cancer.”

The additional HCFA reimbursement approvals also are expected to aid in the growth of mobile PET equipment sales and mobile services to facilities looking to provide PET imaging for patients.