Under a national coverage analysis opened May 8, CMS says it will evaluate whether to cover positron emission tomography more broadly for the staging of cervical cancer outside of clinical studies.

CMS' reconsideration of the issue, which stems from an April national coverage determination, responds to a request from several professors of radiology and oncology. Last month, CMS removed some coverage with evidence development (CED) restrictions for PET scans for a variety of oncology indications, but kept CED requirements in place for most cervical cancer cases (¹ Also see "Oncology PET Scan Coverage Expands As CMS Lifts Some Data Mandates" - Medtech Insight, 13 April, 2009., p. 5).

In the initial treatment phase for cervical cancer, PET is covered without data collection requirements only if conventional imaging is negative for extra-pelvic metastasis.

In an April 14 letter to CMS, Washington University School of Medicine professors Perry W. Grigsby and Barry A. Siegel say they believe CMS did not mean to continue to exclude PET coverage for other newly-diagnosed cervical cancer patients, since the April 3 NCD "was designed to establish a consistent general coverage framework for similar cancers and similar clinical oncology decisions, and to obviate cancer-by-cancer coverage determinations across every family of related cancers."

CMS already covers PET without CED for some cervical cancer patients in the subsequent treatment phase, such as in determining whether cancer treatments have been effective or whether post-treatment symptoms can be attributed to a recurrence.

The professors note that PET is not helpful for the initial diagnosis of cervical cancer, and ask that PET be non-covered for that purpose. The disease, which is initially diagnosed by biopsy, affects about 11,000 women each year, and nearly 4,000 die annually. Other tests that help stage cervical cancer include exploratory surgery and endoscopic procedures.

Although the requestors ask for an expedited review, CMS plans to issue a proposed decision memo by Nov. 8 and a final ruling by Feb. 6, 2010. Comments are due June 7.

- Monica Hogan (m.hogan@elsevier.com)

CMS Considers Broadened PET Scan Coverage For Staging Of Cervical Cancer

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