CMS Allows Medicare Coverage Of Brain Scans For Elderly Patients That May Be Suffering From Either Alzheimer's Disease Or Fronto-Temporal Dementia

Author:Ms Jeannine McGregor
Profession:Foley & Lardner

Executive Summary

Action: The Centers for Medicare and Medicaid Services recently determined that under certain circumstances, a brain scan will be covered by Medicare when used for the diagnosis and treatment of patients that may be suffering from either Alzheimer's Disease or Fronto- Temporal Dementia.

Impact: The use of a certain type of brain scan may be considered reasonable and necessary for patients suffering from dementia, who have displayed a cognitive decline of at least six months. A brain scan is covered under Medicare for patients who meet the diagnostic criteria for both Alzheimer's disease and frontotemporal dementia if the scan will be useful for identifying the cause for their clinical symptoms.

Effective Date: September 15, 2004.


A brain scan known as fluoro-Dglucose Positron Emission Tomography (FDG-PET), is now available for Medicare beneficiaries with certain types of dementia. FDG-PET can also aid in the assessment and prognosis of individuals at increased risk for dementia. The recent coverage determination issued by The Centers for Medicare and Medicaid Services (.CMS.) on September 15, 2004, states that the use of FDG-PET may be reasonable and necessary for beneficiaries, diagnosed with dementia, who have suffered from a cognitive decline for at least six months and who meet the diagnostic criteria for both Alzheimer's disease (Alzheimer's) and fronto-temporal dementia (FTD).


FDG-PET is a minimally invasive. diagnostic imaging procedure, which can be used to evaluate glucose metabolism in the brain. The procedure begins with an injection into the patient of fluoro-D-glucose (FDG), a radioactive substance that emits subatomic particles, known as positrons, as it decays. The test involves a visual interpretation of the scan's images, because metabolically active areas of the body .light up. on an FDG-PET scan more than less active areas. FDG-PET is used to differentiate abnormalities in metabolic functions and displays this information as differences in the brightness of various parts of the brain.

Distinguishing Alzheimer's Disease and Fronto-Temporal Dementia

Although Medicare covers position emission tomography (PET) for diseases such as cancer, ischemic heart disease, and certain neurological disorders, until now, CMS refused to cover PET for the evaluation of elderly patients diagnosed with dementia. CMS has recently reconsidered its coverage decision and has determined that under...

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