Appendix E - National Coverage Determinations Manual / 220.6.2

Why This Topic Matters

Coverage determinations affect whether services are payable and what supporting record elements may be expected. Understanding the article helps coders and billing professionals recognize when this Medicare policy applies and where the guidance has changed over time.

Article Sections

1. FDG PET for Lung Cancer (Various Effective Dates Below)

   Overview of the Medicare policy entry and its effective-date framework. The section establishes that the article addresses FDG PET coverage guidance for lung cancer across multiple time periods.

2. Characterization of Single Pulmonary Nodules (SPNs)

   Discussion of coverage for evaluation of pulmonary nodules and the documentation context associated with that use. The section also addresses the relationship between PET and other diagnostic imaging.

3. Initial Staging of Non-Small-Cell Lung Carcinoma (NSCLC)

   Coverage guidance for early staging-related use of FDG PET in lung cancer. The section describes the clinical setting and the coordination of PET with other diagnostic findings.

4. Diagnosis, Staging, and Restaging of NSCLC

   Broader Medicare coverage language for FDG PET in NSCLC beginning with the later effective date. The section covers the general diagnostic and staging framework referenced in the manual.

5. Monitoring response to treatment of NSCLC

   Coverage guidance for treatment-response monitoring in NSCLC under a coverage-with-evidence-development context. The section also references how providers are informed about access pathways and documentation expectations.

6. Requirements

   General criteria and documentation themes associated with PET coverage across cancer-related scenarios. The section outlines the broad categories of clinical situations discussed in the policy.