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PET Scan Coverage Moving Forward
By Greg Brozeit

The head of the Center for Medicare and Medicaid Services (CMS), Mark McClellan announced that his agency would rule on the coverage of PET scans for myeloma patients by the end of September 2004.  McClellan made the statement in response to a question posed by Sen. Bob Graham (D-FL) at a hearing before the Senate Finance Committee on September 14, 2004 .

Prior to the hearing on September 7-9, Dr. Brian Durie, Chairman and cofounder of the International Myeloma Foundation, attended a symposium sponsored by the Institute for Molecular Technologies in Washington , DC to urge Congress and federal policy makers to expand Medicare coverage for PET scans for many diseases, including multiple myeloma.

Dr. Durie presented a session on the efficacy of PET scans for myeloma diagnosis and treatment.  A number of members of Congress, led by Senate Appropriations Committee Chairman Ted Stevens (R-AK), spoke at the meeting and pledged their support to urge Medicare to cover PET scans at the highest rates possible. 

Based on previous statements made by officials from the Center for Medicare and Medicaid Services (CMS) and guidelines published in the Federal Register on August 16, 2004 in “Changes to the Hospital Outpatient Prospective Payment System,” it seems very likely that Medicare will provide coverage for PET scans for myeloma patients and other diseases.  However, the extent of coverage for PET scans and for the radiopharmaceutical needed to perform the scans is still under review.

CMS has set an October 8, 2004 deadline for comments and will announce its decision sometime after that date.  The IMF will respond to the CMS proposals.  Updates will be provided in future editions of the Myeloma Minute.

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