Part B Insider (Multispecialty) Coding Alert

Published on Thu Mar 17, 2005 PDF

If you have cancer patients who could benefit from positron emission tomography (PET) scans, then now is the time to enroll them in a clinical study.

Medicare will cover FDG PET scans for brain, cervical, ovarian, pancreatic, small cell lung and testicular cancers, according to Medicare Change Request 3741. But coverage only applies if your patient is involved in a clinical trial meeting the requirements of the Food and Drug Administration category B investigational device exemption (42 CFR 405.201).

Although Medicare provides national coverage for PET scans for cervical cancer, you must meet certain criteria. For example, you must have already made a pathological cervical cancer diagnosis before the PET scan. Also, you need to report other imaging results and the conventional imaging test results must be negative for extra-pelvic metastasis to receive payment.

Medicare only covers cervical cancer PET scans for metastases detection during the pre-treatment management phase in newly diagnosed patients with locally advanced cervical cancer.