CMS recently proposed significant changes to Medicare’s 2024 coverage of PET scans. Previously, Medicare only covered amyloid PET scans under the coverage with evidence development (CED) program, which limited their use to individuals participating in clinical trials. However, in October 2023, CMS announced its intention to remove these restrictions, empowering regional Medicare administrators called Medicare Administrative Contractors (MACs) to make local coverage determinations for PET scans starting in 2024.
MACs are expected to use evidence-based processes to make their coverage determinations, which should encourage consistent coverage across regions for appropriate Medicare beneficiaries, according to CMS. Furthermore, they can better take into consideration local clinical environments and institutional factors to make these decisions.
This expansion of coverage should provide greater access to amyloid PET scans for Medicare beneficiaries diagnosed with (or who are suspected to have) Alzheimer’s disease, thereby better facilitating timely diagnosis and treatment, says Dr. Kelley.
What It Means for Quality of Care
Amyloid PET scans play an important role in the diagnosis and treatment of Alzheimer’s disease, explains Dr. Kelley. “[Without Medicare coverage], amyloid PET scans would be prohibitively expensive for many patients suspected of having Alzheimer’s disease,” he adds.
Medicare coverage of amyloid PET scans can help health care providers more accurately diagnose Alzheimer’s disease cases and identify patients who may benefit from newly approved medications on the market. This access to earlier detection, as well as more accurate treatment recommendations, is expected to improve the quality of life of both affected individuals and their loved ones, adds Dr. Kelley.
