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March 21 - CMS Rejects PET Coverage for Infection and Inflammation

CMS has posted a final decision rejecting coverage for PET exams for infection and Inflammation. The decision summary and links follow:

Decision Summary

Based upon our review CMS has determined that the evidence is inadequate to conclude that FDG PET for chronic osteomyelitis, infection of hip arthroplasty and fever of unknown origin improves health outcomes in the Medicare populations and therefore has determined that FDG PET for chronic osteomyelitis, infection of hip arthroplasty and fever of unknown origin is not reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act.

We are continuing our national noncoverage of FDG PET for these indications. CMS has also determined that the request for coverage is not appropriate for the Coverage with Evidence Development (CED) paradigm.

Full Decision is located at https://www.cms.hhs.gov/MCD/viewdecisionmemo.asp?id=207

Source: Society of Nuclear Medicine

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