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PET scan vs Cerebrospinal fluid (CSF) test
I was recently diagnosed with Amnestic Mild Neurocognitive Disorder which is said to be a transitional stage between normal age-related cognitive decline and more severe dementia, such as Alzheimer's disease. To eliminate possible causes, my physician has referred me for one of the following tests:
- Positron Emission Tomography (PET) scan
- Cerebrospinal fluid (CSF) test
I'd like to do the PET scan since the CSF test requires a lumbar puncture which could be painful. Unfortunately, my insurance covers the CSF but not the PET scan.
If anyone has experienced the Cerebrospinal fluid test, I'd be grateful to know how it went for you.
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Yes - its not that the CSF draw itself is painful. But occasionally a puncture hole may result in a teensy leak when the needle is withdrawn. The CSF channel is an extremely precise, barometric balanced, closed loop pressure system. If the puncture hole doesn't seal off when the needle is removed, the result is a massive headache from the pressure change. You have to lay flat and still as you can until your body seals it off or the Doc applies a drop of your blood to patch it. Once it stabilizes the pain reduces unless you move again. You will definitely know when pressure balance is restored and you can change position.
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2 ReactionsWell of course cost is the reason. But its not clear to me they can disallow a PET
FDA-approved approved Leqembi® is the latest medication for Alzheimer’s treatment. That means Medicare Part B now covers the pricey drug.
However, Part B enrollees are still responsible for 20% of Leqembi’s cost, currently listed by its manufacturer at $26,500 annually.
Patients with early-stage Alzheimer’s qualify for Leqembi, and Medicare coverage depends on being enrolled in a registry, among other rules.
Centers for Medicare & Medicaid Services | CMS (.gov)
https://www.cms.gov › view › ncd
NCD - PET (FDG) for Dementia and Neurodegenerative Diseases (220.6.13)
An FDG-PET scan is considered reasonable and necessary in patients with a recent diagnosis of dementia and documented cognitive decline of at least 6 months, ...
You have a the right to contest any Medicare decision. But you might wish to speak with your docs billing specialist to see what the precise issue is. If all your prequalifying data is correct then I’m guessing the coding is incorrect and necessary for it to pass muster to authorize the test. You should also check out the LCD for the local Medicare contractor who processes your claims. They could have a stipulation you’re not aware of.
As of December 1, 2023, the Centers for Medicare and Medicaid Services (CMS) has removed National Coverage Determination (NCD) 220.6.20, which limits patients' ability to qualify for PET beta-amyloid imaging. This decision expands access to PET scans for patients with Alzheimer's disease and other neurodegenerative diseases. Medicare Administrative Contractors (MACs) will now be able to determine coverage for these scans, and the once-in-a-lifetime requirement for PET beta-amyloid imaging has been removed.
And if the leak does not repair itself then you will likely develop SS. That’s what happened to me. Please see Mayo clinic/ Steve GRINSTEAD.
What is SS?