Appendix E - National Coverage Determinations Manual / 220.6.5

Why This Topic Matters

Coverage policy changes can affect whether a claim is payable and what supporting documentation is expected. Understanding the scope and timing of this guidance helps organizations align billing, medical record support, and utilization review with Medicare requirements.

Article Sections

1. FDG PET for Lymphoma (Various Effective Dates Below)

   Overview of Medicare coverage policy for FDG PET in lymphoma across several effective dates. Introduces the major coverage contexts addressed in the article.

2. Staging and Restaging as Alternative to Gallium Scan

   Discusses the earlier coverage framework for lymphoma staging and restaging in relation to alternative imaging. Includes related documentation and timing considerations.

3. Diagnosis, Staging, and Restaging

   Covers the expanded Medicare policy for lymphoma diagnosis, staging, and restaging. Summarizes the general coverage scope and documentation expectations.

4. Monitoring Response to Treatment

   Addresses the later coverage approach for monitoring treatment response in lymphoma. Includes the evidence-development context and provider notification framework.