Medicare to Cover PET Scans in Cases Where Dementia Diagnosis Is Unclear

Article excerpt

Medicare is extending coverage of PET scans to include patients who meet the criteria for both frontotemporal dementia and Alzheimer's disease but for whom the diagnosis remains unclear.

The Centers for Medicare and Medicaid Services concluded in September that [.sup.18]fluorodeoxyglucose PET (FDG-PET) imaging can be useful in patients with a documented cognitive decline of at least 6 months and a recently established diagnosis of dementia.

To be eligible for the new coverage, these patients must meet criteria for both frontotemporal dementia (FTD) and Alzheimer's disease (AD), but have an unclear diagnosis even after extensive clinical evaluation and alternative imaging (MRI and CT).

The specific conditions required to receive PET scan coverage to distinguish FTD and AD include:

* The onset, clinical presentation, or course of impairment is atypical for AD, and FTD is suspected as an alternative neurodegenerative cause.

* The patient has had a comprehensive clinical evaluation--as defined by the American Academy of Neurology--encompassing a medical history from both the patient and a well-acquainted informant, a physical and mental status examination aided by cognitive scales or neuropsychological testing, laboratory tests, and structural imaging.

* The patient has been evaluated by a physician experienced in the diagnosis and assessment of dementia.

* The evaluation did not identify a likely, specific neurodegenerative disease that is causing the clinical symptoms.

It's estimated that 12%-16% of patients with degenerative dementia may have FTD, which is often misdiagnosed as AD. …