Medicare and NOPR
Registry Indications
Registry Covered Indications
CMS expanded coverage for FDG-PET to include all cancers and indications
not presently eligible for Medicare reimbursement, but does not include
PET performed as part of a clinical trial nor indications that are currently
labeled as "non-covered".
Non-Covered Indications
- Breast cancer -
diagnosis
- Breast cancer -
initial staging axillary lymph nodes
- Melanoma - initial
staging regional lymph nodes
Additional
Indications Covered Through the Registry
The NOPR will significantly expand coverage while conducting a study on
PET's effectiveness for currently non-covered cancers. This offers
tremendous opportunity for demonstrating effective management of cancer
patients and for the expansion of PET covered indications. Listed below
are many potentially useful applications of PET imaging by indication.
You should consult with the PET center physicians to discuss appropriate
use of PET in specific patients.
Bladder Cancer
- Primary nodal staging
- Systemic metastases
staging
- Evaluate local
extent of disease and exclude lymph node involvement or distant metastases
Brain Tumor
- Diagnosing and
grading the malignancy
- Determining the
extent for treatment planning
- Directing biopsy
(This helps to determine where in the brain to sample the tissue, by
differentiating tumor from necrosis and edema.)
- Determining prognosis
- Determining the
extent of tumor in treatment planning
- Monitoring response
to treatment (surgery/radiotherapy/chemotherapy)
- Differentiate tumor
from radiation necrosis and edema
- Determine how well
the treatment affected the tumor
- Differentiate primary
CNS lymphoma from toxoplasmosis
- Exclude metastatic
disease of the brain
- Evaluating efficacy
of surgery and radiation treatment
Hepatocellular
Cancer
- Distinguishing
between cirrhosis and hepatoma
- Evaluate local
extent of disease and exclude lymph node involvement or distant metastases
- Identifying multifocal
lesions
- Assessing response
to treatment and differentiating tumor from necrosis, edema, and scarring
Musculoskeletal
Tumors
- Evaluate local
extent of disease and exclude distant metastases
- Measure treatment
response and exclude recurrent/residual tumor following definitive therapy
Ovarian Cancer
- Staging lymph nodes
- Assessing response
to treatment
- Evaluate suspected
recurrence
- Identifying recurrent
disease after surgery and radiation
- Detect recurrent/residual
tumor prior to surgical exploration or additional chemotherapy
Pancreatic
Cancer
- Characterization
of a radiographically occult lesion
- Differentiation
of chronic pancreatic masses from cancer
- Differentiation
of benign processes such as pancreatitis, mucinous cyst adenoma and
pseudocyst from malignant disease
- Rule out distant
metastases for preoperative evaluation
- Staging nodal and
liver metastases
- Assessing response
to chemotherapy
Prostate Cancer
- Characterization
of a radiographically occult lesion
- Evaluate local
extent of disease and exclude distant metastases
Renal Cell
Cancer
- Determining nature
of renal masses
- Detecting and evaluating
local disease spread and metastatic disease
- Assessing response
of metastases to chemotherapy
- Detect recurrent/residual
tumor prior to surgical exploration or additional chemotherapy
Small Cell
Lung Cancer
- Staging lymph nodes
- Assessing response
to treatment
- Evaluate suspected
recurrence
- Identifying recurrent
disease after surgery and radiation
Soft Tissue
Sarcoma (this is a reversal from non-coverage)
- Visualization of
soft tissue sarcoma
- Determine tumor
malignancy grade before treatment
- Identify nodal
involvement and local metastases
- Tailor treatment
protocol based on tumor grade
- Assess response
to presurgical treatment
- Assessment of bony
healing in those patients who have received allograft transplants
- Assessment of high-risk
pediatric patients being treated for Ewing's sarcoma and osteosarcoma.
- Identify tumor
recurrence
Stomach Cancer
- Characterization
of a radiographically occult lesion
- Evaluating efficacy
of surgery and radiation treatment
Testicular
Cancer (this is a reversal from non-coverage)
- Staging of primary
disease
- Assessing residual
mass
- Further evaluating
raised markers
- Characterization
of a radiographically occult lesion
- Guide biopsy or
surgical procedure
- Monitoring response
to treatment
Unknown Primary
- Identifying primary
site to determine treatment and evaluate for possible resection
Uterine Cancer
- Staging lymph nodes
- Assessing response
to treatment
- Evaluate suspected
recurrence
- Identifying recurrent
disease after surgery and radiation
All other
cancers not listed
- Staging lymph nodes
- Assessing response
to treatment
- Evaluate suspected
recurrence
- Identifying recurrent
disease after surgery and radiation
Expanded
Coverage for Thyroid Cancer and Cervical Cancer
Thyroid Cancer
- Diagnosis
- Staging
- Monitoring response
to therapy
- Other restaging
- Other cancer types
(medullary, anaplastic)
- Further evaluation
for medullary thyroid cancer when rising calcitonin level and initial
imaging with dimercaptosuccinic acid V, octreoscan, or metaiodobenzylguanidine
is negative
Cervical Cancer
- Diagnosis
- Other staging
- Monitoring response
to therapy
- Restaging
- Staging lymph nodes
- Identifying recurrent
disease after surgery and radiation
Expanded
Coverage includes Evaluation of Treatment Response
- Non small cell
lung cancer
- Esophageal Cancer
- Head & Neck
Cancer
- Colorectal Cancer
- Lymphoma
- Melanoma
Next: General
Medicare Information
Previous: About NOPR
|
