HCFA expands PET coverage

After months of intense lobbying efforts, PET advocates received good news this month when the Health Care Financing Administration agreed to expand its reimbursement coverage for PET applications. According to ADAC Laboratories of Milpitas, CA, HCFA announced March 10 that in addition to covering cardiac and lung cancer applications (the latter including both PET and coincidence detection techniques), it will cover PET scans used to diagnose and manage three additional oncology applications: colorectal cancer, Hodgkin’s and non-Hodgkin’s lymphoma, and melanoma.

Last June, HCFA established a solid reimbursement rate of $1980 for cardiac and lung cancer imaging applications, exceeding many industry watchers’ expectations (SCAN 6/10/98). But PET advocates continued to negotiate with HCFA for more coverage. In January, representatives of the nuclear medicine community, including the Institute for Clinical PET of Foothill Ranch, CA, as well as practitioners, vendors, and patients, met with HCFA officials in Baltimore to discuss expanding reimbursement (SCAN 3/3/99 and 2/17/99). PET advocates argued that HCFA’s clinical validation standards were too rigorous. Although some progress was made, the meeting ended inconclusively.

The agency surprised lobbyists with this month’s announcement, which opens the door to increased patient access to the technology.

“We are particularly pleased (with HCFA’s decision) because more patients will have access to this significant diagnostic tool,” said Ruth Tesar, president of the ICP.