tci Medicare Compliance & Reimbursement - 2004 Issue 37

Coverage: PET Coverage May Herald New Era In Clinical Trials

With evidence limited on effectiveness, coverage too will be limited.The Centers for Medicare & Medicaid Services announced a National Coverage Decision Sept. 16 extending Medicare coverage for positron emission tomography to some beneficiaries with signs of dementia.Beneficiaries who meet diagnostic criteria for both Alzheimer's and fronto-temporal dementia but for whom evaluations for specific alternate causes of the dementia have produced no clinical answer are now covered for a PET scan to determine whether they suffer from Alzheimer's.CMS recognizes that PET also may be useful for patients in the early stages of dementia, both as a diagnostic...

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