Positron Emission Tomography (FDG) for Cervical Cancer

CMS NCA document | source_status=Closed | review_type=2nd Recon | public_comment_open=False | document_id=CAG-00181R2

CMS was asked to reconsider Section 220.6 of the National Coverage Determinations Manual to end the prospective data collection requirements for FDG PET for initial staging of cervical cancer. CMS has concluded that the evidence is adequate to determine that the results of FDG PET imaging for cervical cancer staging of beneficiaries diagnosed with cervical cancer are used by the treating physician to make meaningful changes in therapeutic management and improve health outcomes, and thus are reasonable and necessary under §1862(a)(1)(A) of the Act. Therefore, CMS will cover only one FDG PET for staging for beneficiaries who have biopsy proven cervical cancer when the beneficiary’s treating physician determines that the FDG PET study is needed to determine the location and/or extent of the tumor for the following therapeutic purposes related to the initial treatment strategy: To determine whether or not the beneficiary is an appropriate candidate for an invasive diagnostic or therapeutic procedure; or To determine the optimal anatomic location for an invasive procedure; or To determine the anatomic extent of tumor when the recommended anti-tumor treatment reasonably depends on the extent of the tumor. The requestor also noted that "CMS may find it appropriate to exclude coverage for diagnosis of cervical cancer since this disorder is initially diagnosed by biopsy". CMS agrees that there is no credible evidence that the results of FDG PET imaging are useful to make the initial diagnosis of cervical cancer, and therefore do not improve health outcomes, and thus are not reasonable and necessary under §1862(a)(1)(A) of the Act. Therefore CMS will noncover FDG PET for this indication.