Increased PET Scan Coverage for Alzheimer’s Patients

July 21, 2023 On Monday, July 17, the Centers for Medicare and Medicaid Services (CMS) announced the proposal of increased coverage for Beta Amyloid PET scans used to diagnose Alzheimer’s disease. Among other tests and assessments to diagnose Alzheimer’s, doctors use positron emission tomography (PET) scans to view changes in the brain. A PET scan…

July 21, 2023

On Monday, July 17, the Centers for Medicare and Medicaid Services (CMS) announced the proposal of increased coverage for Beta Amyloid PET scans used to diagnose Alzheimer’s disease.

Among other tests and assessments to diagnose Alzheimer’s, doctors use positron emission tomography (PET) scans to view changes in the brain. A PET scan can provide brain imaging that doctors use to help diagnose Alzheimer’s disease.

In 2013, CMS released the decision to cover a single PET scan per beneficiary when used in approved clinical trials. As the Alzheimer’s field continued to advance, the use of amyloid PET scans did too. CMS’s 2023 proposed decision memo on Beta Amyloid PET in Dementia and Neurodegenerative Disease states, “stakeholders and patients have specifically noted that the once in a lifetime limit on amyloid PET is outdated and not clinically appropriate due to the development of antiamyloid treatments and the need to confirm the presence of amyloid to start these treatments and to possibly discontinue treatments when brain amyloid has been completely removed to avoid unnecessary treatment harms.”

CMS’s proposal discards the one-time-limit policy. Increased coverage of Beta Amyloid PET scans may make it easier for Medicare beneficiaries with Alzheimer’s disease to receive treatment.

This news is released alongside CMS’s announcement of potential coverage for a new Alzheimer’s drug, Leqembi. PET scans may help determine patient eligibility for new treatments, or whether dementia treatments are performing as intended.

Related Medicare News: New Alzheimer’s Drug Pending Full FDA Approval