PET Scan


Yakima, WA
Best answers
I have some confusion about PET scans. I have reviewed the NCD and understand what is covered/not covered and how things tie into the NOPR. What is confusing me is a Medicare part B newsletter from my local carrier (Noridian) dated 4/15/2012, and it seems to contradict what I thought I understood in reading the NCD.

For example a 78811. They break the ICD-9 codes into several different lists. My two codes are on list one, and the way I read this newsletter this CPT should be covered for initial or subsequent PET because my ICD-9 codes are on list 1. This completely contradicts the NCD and the NOPR list. If my ICD-9 codes were on say list 2 then the 78811 could only be covered under CED.

If Noridian is your carrier, and you can help explain this to me, I would really appreciate it.