Appendix E - National Coverage Determinations Manual / 220.6.6

Why This Topic Matters

Coverage rules for imaging in melanoma can affect medical necessity review, claim support, and compliance with Medicare policy. Understanding the effective dates and the broad categories of covered use helps billing and utilization review teams interpret whether an encounter falls within the policy scope.

Article Sections

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

   Introduces the Medicare policy topic and the time-based structure of the coverage guidance for melanoma-related PET services.

2. Evaluation of Recurrent Melanoma Prior to Surgery As Alternative to Gallium Scan

   Covers the earliest policy category for recurrent melanoma evaluation before surgery and includes administrative notes about frequency, documentation, and facility-related limitations.

3. Diagnosis, Staging, and Restaging

   Addresses the policy category for diagnostic and disease-assessment uses of FDG PET in melanoma, along with related documentation context.

4. Monitoring Response to Treatment

   Describes the later policy category for monitoring treatment response and references the coverage-with-evidence-development framework and access notice provisions.

5. Requirements

   Summarizes the general clinical situations and documentation framework discussed for PET coverage under the policy.