National_Coverage_Determinations_Manual / POSITRON_EMISSION_TOMOGRAPHY_(PET)_SCANS

Why This Topic Matters

PET coverage is highly indication-specific and changed across multiple effective dates. Understanding the scope of Medicare’s policy helps users determine whether an article is relevant to a particular diagnostic scenario or coverage period and whether additional CMS guidance may apply.

Article Sections

1. General Description

   Introduces PET scanning, FDG tracer use, and the overall framework for Medicare coverage of the procedure. Summarizes the major clinical categories addressed in the manual section.

2. Coverage table of clinical conditions and effective dates

   Presents the main list of PET-covered clinical conditions with associated effective dates and coverage categories. Also identifies broad areas discussed as covered, non-covered, or covered with evidence development.

3. EFFECTIVE JANUARY 28, 2005

   Describes the CMS approach for cancer indications under coverage with evidence development and the types of prospective studies referenced. Includes access-notification pathways for available services.

4. Indication coverage summary table

   Provides a structured summary of which cancer indications are covered nationally, non-covered nationally, or covered only in specific settings. Includes broad monitoring-related categories and other listed cancer groupings.

5. General Conditions of Coverage for FDG PET

   Explains allowable FDG PET systems and general administrative conditions tied to coverage. Addresses FDA-approved system terminology and documentation expectations.

6. Covered Indications for PET Scans and Limitations/Requirements for Usage

   Sets out broad coverage limitations and requirements for malignancy-related PET use across diagnosis, staging, restaging, and monitoring. Also notes general rules about screening and frequency considerations.