CMS Expands Coverage for PET Imaging Related to Alzheimer Disease

In a new policy change, the Centers for Medicare & Medicaid Services (CMS) have announced that they will cover the cost of PET imaging used for the diagnosis of Alzheimer disease (AD). The decision memo states that the CMS is eliminating previous restrictions which supported the cost of PET amyloid beta (Aβ) imaging only when used in clinical trials. Under this new policy, coverage determinations will be made by Medicare Administrative Contractors (MAC), and the current limitation of 1 scan per lifetime will be removed.

This policy change has been applauded by multiple groups, including the Alzheimer’s Association and the Society for Nuclear Medicine & Molecular Imaging. PET imaging is the gold standard for confirming the presence of Aβ in the brain and can be used to assist in the diagnosis of Alzheimer disease and other dementias. PET scans also can be performed during treatment with anti-amyloid monoclonal antibody medications such as Leqembi (lecanemab-irmb; Eisai, Tokyo, Japan; Biogen, Cambridge, MA) to monitor the reduction of Aβ plaques. By covering PET imaging, CMS intend to ensure that patients who require these medications will have access to them, while preventing patients who do not have Aβ present in their brain from receiving anti-amyloid treatments, which may result in harm.

"Amyloid PET scans are a proven tool and can be an important part of Alzheimer's diagnosis and treatment," said Maria C. Carrillo, PhD, Chief Science Officer of the Alzheimer's Association. "Broader access to amyloid PET scans will enable earlier and more accurate diagnosis, and better care management. Their use can lead to better health outcomes for people living with Alzheimer's or another dementia."