Table 1. Applications of FDG-PET covered by the Centers of Medicare and Medicaid (CMS) as of April 3, 2009.
| Tumor Type | Initial Treatment Strategy * | Subsequent Treatment Strategy ** |
|---|---|---|
| Colorectal | Cover | Cover |
| Esophagus | Cover | Cover |
| Head & Neck (not Thyroid, CNS) | Cover | Cover |
| Lymphoma | Cover | Cover |
| Non-Small Cell Lung | Cover | Cover |
| Ovary | Cover | Cover |
| Brain | Cover | CED |
| Cervix | 1 or CED | Cover |
| Small Cell Lung | Cover | CED |
| Soft Tissue Sarcoma | Cover | CED |
| Pancreas | Cover | CED |
| Testes | Cover | CED |
| Breast (female and male) | 2 | Cover |
| Melanoma | 3 | Cover |
| Prostate | N/C | CED |
| Thyroid | Cover | 4 or CED |
| All Other Solid Tumors | Cover | CED |
| Myeloma | Cover | Cover |
| All other cancers not listed herein | CED | CED |
Formerly “diagnosis” and “staging”
Formerly “restaging” and “monitoring response to treatment”
CED: covered under CMS with evidence development paradigm
N/C = not covered
(1) Cervix: Covered for the detection of pre-treatment metastases (i.e., staging) in newly diagnosed cervical cancer subsequent to conventional imaging that is negative for extra-pelvic metastasis. All other initial treatment strategies are CED.
(2) Breast: Not covered for initial diagnosis and/or staging of axillary lymph nodes; covered for initial staging of metastatic disease.
(3) Melanoma: Not covered for initial staging of regional lymph nodes. All other initial staging uses are covered.
(4) Thyroid: Covered for subsequent treatment strategy of recurrent or residual thyroid cancer of follicular cell origin previously treated by thyroidectomy and radioiodine ablation and have a serum thyroglobulin >10ng/ml and have a negative I-131 whole body scan. All other uses for subsequent treatment strategy are CED.
(This National Coverage Determination was last reviewed April 2009.)