Medicare

The Centers for Medicare and Medicaid Services (CMS) coverage policies for PET and PET/CT indications are decided at a national level and are documented in a National Coverage Determination (NCD), section 220.6 Medicare Covered Indications.

In April 2009, CMS announced a new coverage policy for oncologic PET scans. Under this new policy, CMS expanded coverage for the use of PET for initial treatment strategy evaluation (formerly diagnosis and initial staging) of patients with nearly all cancer types, and allowed the use of PET for subsequent treatment strategy evaluations (formerly restaging, detection of suspected recurrence and treatment monitoring) for an expanded number of cancer types.

Click here to view CMS Decision Memo for Solid Tumors (CAG-00181R)

Click here to view a brief recap and table of Medicare coverage for oncologic uses of FDG PET, effective November, 2009.

Click here to view a Billing and Reimbursement Quick Reference Guide

For general Medicare information, Medicare enrollees can access all aspects of the Medicare program at http://www.medicare.gov/ or by calling Medicare at 800-633-4227.

Disclaimer
This information provided by PETNET Solutions is based on published guidelines and on our experience. It is provided for general information only, as a service and at no charge to our customers. It is based on information found in published CMS National Coverage documents, but is not all-inclusive. We believe that the information set forth herein is generally accurate; however, we cannot provide assurance that it is complete, accurate or current. Always check with your local insurance carriers, as coverage may vary by region. The referring physician is responsible for pre-authorization and providing proof of medical necessity for any PET scan. PETNET Solutions and its representatives hereby expressly disclaim any and all liability for claims, including bodily injury or death, arising from any reliance on the information set forth herein.