Medicare: Eli Lilly spurns CMS refusal to cover PET scans with beta-amyloid agents

Medicare regulators reject reimbursement coverage for positron emission tomography beta-amyloid imaging, with exceptions for use in excluding Alzheimer’s disease and in “clinically difficult differential diagnoses.”

The Centers for Medicare & Medicaid Services ruled against new reimbursement coverage for beta-amyloid imaging agents in use with positron emission tomography scans with exceptions for certain indications.

The CMS ruling denied coverage for most PET Aβ scans, saying that there was “insufficient evidence” that such imaging is “reasonable and necessary” for the indications examined. The healthcare regulators granted 2 exceptions: