The Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the American Society of Nuclear Cardiology (ASNC) submitted a letter to BlueCross BlueShield (BCBS) of Tennessee urging an expansion of cardiac PET coverage.
BCBS of Tennessee’s proposed policy for the expansion of cardiac PET labels it as "investigational" and may deny coverage for absolute quantification of myocardial blood flow.
“Blood ﬂow quantiﬁcation at rest and stress is used to measure myocardial ﬂow reserve,” ASNC and SNMMI noted in its letter. “It allows veriﬁcation of adequate stress response, further improving interpretation conﬁdence. Regional ﬂow reserve shows the physiological signiﬁcance of epicardial CAD, analogous to invasive fractional ﬂow reserve (FFR). In the absence of epicardial CAD, ﬂow reserve allows the assessment of microcirculatory function. The ability to routinely quantify myocardial blood ﬂow in ml/min/gram is unique to PET, improves accuracy, risk stratiﬁcation, and patient selection for interventions.”
The letter noted non-coverage does not align with a previous joint position paper from SNMMI and ASNC that determined measuring blood flow absolutely, instead of comparatively, increases the chances of defining patients with severe coronary artery disease (CAD).
SNMMI and ASNC discussed support for BCBS’s proposed coverage for patients with “significant” left ventricular dysfunction that is being considered for revascularization and a suspected cardiac sarcoid. Additionally, they also support BCBS’s proposal to lower the BMI figure for covered patients from 35 to 30 percent.
“The literature supports the high diagnostic accuracy and prognostic value in this patient group because they are prone to poor image quality with SPECT and stress echo,” they wrote.