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Question Amyvid PET scans Coding and billing guidelines

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krithika_babu

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Has anyone received updated guidance or payer policy criteria for coding/authorizing Amyvid (amyloid PET imaging)?

I am seeing exclusion criteria listed such as:

  • Prior intracerebral hemorrhage
  • Severe white matter disease
  • Vasogenic edema
  • Seizures
  • Stroke/TIA within the last 12 months
  • Behavioral disturbances interfering with evaluation
  • Dementia with Lewy Bodies (DLB)
  • Vascular dementia
  • Pseudodementia due to mood disorder
  • Traumatic brain injury (TBI)
  • Encephalopathy
  • Frontotemporal dementia (FTD)
My question is: if the patient does NOT have any of the above conditions, does that support medical necessity/eligibility for Amyvid PET imaging under the newer policies?Would appreciate any coding or authorization insight others are using.
 
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