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Reimbursement News
CMS Rescinds Billing Instructions from April NCD Changes
On August 12, 2009, the Centers for Medicare and Medicaid Services (CMS) rescinded transmittal 1772, change request 6464, dated July 17, 2009 and announced it will be replaced at a later date. This transmittal gave instructions on new modifiers (PI, PS and KX) and provided ICD-9 codes for oncologic PET imaging.
This means that for the newly covered indications (subsequent treatment strategy of cervical, ovarian and myeloma and initial treatment strategy of newly covered solid-tumors), the payers are still awaiting final instructions from CMS, therefore they will not be able to process these claims. Providers will receive denials if they bill for them, so they should watch for these denials or continue to hold these claims until the payers are able to process them.
Professional medical societies have contacted CMS regarding the rescinding of these billing instructions as it is believed that this is appropriate and in the best interest of the PET community. CMS is working on finalizing a simplified version of this transmittal. Look for further updates once CMS finalizes and publishes their new instructions.
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Reimbursement News
CMS Posts Draft Decision for FDG PET for Cervical Cancer
On August 13, 2009, the Centers for Medicare and Medicaid Services (CMS) announced a proposed decision to cover FDG PET for one scan for staging in beneficiaries who have biopsy-proven cervical cancer when the scan is needed to guide initial treatment strategy. CMS proposes non-coverage for diagnosis of cervical cancer. This proposal is consistent with the request for reconsideration sent to CMS on April 14, 2009, that asked CMS to lift the CED requirement for initial treatment strategy of cervical cancer. Coverage of cervical cancer for the initial treatment strategy would no longer require a negative conventional imaging study for extrapelvic metastases before the PET scan, nor would it require entry into the NOPR for the initial treatment strategy of cervical cancer which falls outside this limitation.
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View the proposed decision
[FULL STORY]
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Reimbursement News
Comments Concerning CMS Reconsideration to Cover Sodium Fluoride PET Imaging
The Academy of Molecular Imaging (AMI), the American College of Nuclear Physicians (ACNP), the American College of Radiology (ACR), the American Society for Radiation Oncology (ASTRO), and the Society of Nuclear Medicine (SNM), jointly submitted comments regarding CMS reconsideration to cover Sodium Fluoride PET imaging. CMS is in the process of reviewing all of the submitted comments and the literature. The next step will be for CMS to post a draft decision, followed by a 30-day comment period.
To view the comment letter, click here
To view the NaF literature review from the National Institutes of Health,
click here
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Health Update
Cancer Research: Cancer Mortality Declining, Partly Due to Screening
The number of cancer deaths has declined steadily in the last three decades. Although younger people have experienced the steepest declines, all age groups have shown some improvement, according to research published August 13, 2009 in Cancer Research.
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Patient Advocacy
Leukemia & Lymphoma Awareness Month
Every four minutes, one person is diagnosed with a blood cancer.
An estimated 139,860 people in the United States will be diagnosed with leukemia, lymphoma or myeloma in 2009. New cases of leukemia, Hodgkin and non-Hodgkin lymphoma and myeloma account for 9.5 percent of the 1,479,350 new cancer cases diagnosed in the United States this year*.
Overall incidence rates per 100,000 population for leukemia, lymphoma and myeloma are almost identical for data reported in 2008 and 2009 [(leukemia 12.2, 2009 vs.12.3, 2008); (NHL, 19.5, each year); (Hodgkin lymphoma, 2.8, each year); (myeloma, 5.6, each year)].
Leukemia, lymphoma and myeloma will cause the deaths of an estimated 53,240 people in the United States this year. These blood cancers will account for nearly 9.5 percent of the deaths from cancer in 2009 based on the 562,340 total cancer-related deaths.
September marks the national observance of Leukemia and Lymphoma Awareness Month.
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Source: Leukemia, Lymphoma, Myeloma Facts 2009-2010, June 2009.
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Patient Advocacy
September is Ovarian Cancer Awareness Month
An estimated 21,550 new cases of ovarian cancer are expected in the US in 2009. Ovarian cancer accounts for about 3 percent of all cancers among women and ranks second among gynecologic cancers, following cancer of the uterine corpus. During 2001-2005, ovarian cancer incidence declined at a rate of 2.4 percent per year. An estimated 14,600 deaths are expected in 2009. Ovarian cancer causes more deaths than any other cancer of the female reproductive system. Death rates for ovarian cancer have been stable since 1998.
Until recently, ovarian cancer was known as a "silent killer," because it usually wasn't found until it had spread to other areas of your body. But, new evidence shows that most women may have symptoms even in the early stages, and awareness of the symptoms may hopefully lead to earlier detection.
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Source: American Cancer Society. Cancer Facts & Figures 2009. Atlanta: American Cancer Society; 2009.
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Patient Advocacy
September marks Prostate Cancer Awareness Month
Prostate cancer is one of the most treatable cancers. The prognosis for curing prostate cancer and long term survival is excellent when the cancer is caught early and treated effectively.
An estimated 192,280 new cases of prostate cancer will occur in the US during 2009. Prostate cancer is the most frequently diagnosed cancer in men. For reasons that remain unclear, incidence rates are significantly higher in African Americans than in whites. Incidence rates for prostate cancer have changed substantially over the past 20 years, in large part reflecting changes in prostate cancer screening with the prostate-specific antigen (PSA) blood test. After increasing from 1988 to 1992, declining from 1992 to 1995, and again increasing from 1995 to 2001, rates have been decreasing since 2001 by 4.4 percent per year.
With an estimated 27,360 deaths in 2009, prostate cancer is the second-leading cause of cancer death in men. Although death rates have decreased more rapidly among African American than among white men since the early 1990s, rates in African Americans remain more than twice as high as those in whites.
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Source: American Cancer Society. Cancer Facts
& Figures 2009. Atlanta: American Cancer Society; 2009.
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Patient Advocacy
National Childhood Cancer Month is Observed in September
Although uncommon, cancer is the second leading cause of death in children, exceeded only by accidents. An estimated 10,730 new cases are expected to occur among children aged 0 to 14 years in 2009. Childhood cancers are rare, representing less than one percent of all new cancer diagnoses.
An estimated 1,380 deaths are expected to occur among children aged 0 to 14 years in 2009, about one-third of these from leukemia. Although uncommon, cancer is the second leading cause of death in children, exceeded only by accidents. Mortality rates for childhood cancer have declined by 50 percent since 1975. The substantial progress in pediatric cancer survival rates is attributable largely to improved treatments and the high proportion of patients participating in clinical trials.
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Source: American Cancer Society. Cancer Facts & Figures 2009. Atlanta: American Cancer Society; 2009.
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Patient Advocacy
September is Thyroid Cancer Awareness Month
The month of September is Thyroid Cancer Awareness Month. The American Cancer Society estimates that in 2009, 37,200 new cases of thyroid cancer will be diagnosed in the United States, most of them in women.
An estimated 1,630 people will die of thyroid cancer during 2009. Thyroid cancer is, however, considered one of the least deadly and most survivable cancers, and five-year survival rates for thyroid cancer is almost 97 percent.
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Source: American Cancer Society. Cancer Facts & Figures 2009. Atlanta: American Cancer Society; 2009.
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