Appendix E - National Coverage Determinations Manual / POSITRON_EMISSION_TOMOGRAPHY_(PET)_SCANS

Why This Topic Matters

Because PET coverage depends on indication, clinical context, timing, and system requirements, this manual section is important for determining whether a scan falls within Medicare-covered use and for understanding the policy framework behind claims submission and documentation.

Article Sections

1. I. General Description

   Provides an overview of PET imaging and the general scope of the Medicare coverage discussion. It also introduces the categories of clinical conditions addressed in the manual.

2. Effective January 28, 2005

   Summarizes the updated coverage framework for cancer-related PET services and the evidence-development structure referenced by CMS. It includes the general list of indications organized by coverage category.

3. II. General Conditions of Coverage for FDG PET

   Explains the general requirements and definitions that apply to FDG PET coverage. It also outlines the types of PET systems discussed in the manual.

4. III. Covered Indications for PET Scans and Limitations/Requirements for Usage

   Describes the overarching coverage framework for malignancy-related PET use, including diagnosis, staging, restaging, and monitoring. It also notes limitations and general conditions for use.