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Medicare To Expand Use Of PET For Patients With Heart Disease February 20, 2002 - The Centers for Medicare & Medicaid Services (CMS) announced today that it intends to cover positron emission tomography (PET) for use in determining whether certain Medicare patients are good candidates for revascularization -- procedures to improve blood flow to the heart. A national coverage decision to be issued by CMS will make PET available as a primary or initial diagnostic study for determining myocardial viability in patients with ischemic heart disease. "This decision is another example of Medicare making emerging medical technology available to its beneficiaries," said Jeffrey Kang, MD, MPH, director of the CMS Office of Clinical Standards and Quality and the agency's chief clinical officer. "PET already is approved for a variety of other applications, and CMS continues to study its potential for improving health outcomes for Medicare patients." Myocardium is the middle and thickest layer of the heart wall. Myocardial viability refers to whether a patient's myocardium will respond to revascularization (bypass surgery or angioplasty) and will reverse left ventricular dysfunction. Patients with ischemic heart disease -- a condition resulting from obstruction of the coronary arteries -- and left ventricular dysfunction -- when the left side of the heart fails to pump an adequate supply of blood out to the body -- are at risk for increased morbidity and mortality. Successful treatment for these patients lies, in part, in determining which patients will benefit from medical treatment versus surgery that will improve left ventricular function. PET is one diagnostic tool that allows physicians to perform myocardial metabolic imaging studies in order to optimize the selection of patients for revascularization surgery to restore an adequate blood supply. This new policy resulted from a review of PET policy initiated internally at CMS, which decided to expand the coverage after a careful review of scientific data. CMS is issuing a decision memorandum announcing the agency's intention to issue, in the future, a National Coverage decision for PET for the primary or initial diagnostic study for determining myocardial viability. The new policy will be implemented later through instructions to the private contractors who process and pay Medicare claims. More information about this decision can be found at www.hcfa.gov/coverage/8b3-ddd.htm.
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