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PET/CT Procedures
Unlike an MRI, PET/CT does not examine body segments, but clinical indications instead. The clinical indications include:
Oncology: PET/CT studies of the entire body are used to evaluate malignant tumors. PET/CT has been used to evaluate a variety of cancers with an 85-95% degree of accuracy. The most common oncology applications include lung cancer, lymphoma, colorectal cancer, breast cancer, head and neck tumors, melanoma, bone and soft tissue sarcoma. Once the tumor has been located, PET/CT is able to distinguish whether it is benign or malignant. Additionally, once a patient has undergone chemotherapy, PET/CT can assess how effective the treatment has been.
Neurology: The most frequently performed PET study of the brain is a study of glucose metabolism. PET/CT imaging can also be used to detect abnormalities in the brain, making it easier to diagnose neurological disorders.
Cardiology: A valuable utilization of PET is evaluating the clinical necessity for performing diagnostic and therapeutic procedures such as angiography, angioplasty, bypass surgery and cardiac transplantation. For cardiology applications, PET/CT scanning is the most accurate noninvasive test to determine the presence of coronary artery disease or the viability of the muscle.
NOPR: Evidence base data concerning the clinical utility of FDG-PET is currently available for patients which do not meet the clinically approved indications by Medicare. For this reason, Medicare has conditioned coverage of FDG-PET under the NOPR. This data will be used to help determine the clinical utility of FDG-PET for conditionally covered cancers and indications. The referring physician remains responsible for documenting medical necessity, which is required for the coding and billing of both covered and NOPR-eligible PET studies. Eligibility for the NOPR does not constitute a clinical management recommendation for the use of PET for the conditionally covered cancers and indications, by either the Medicare program or NOPR investigators. Referring and interpreting physicians are thus advised to refer to the published literature to better understand the potential limitations of FDG-PET for NOPR-eligible uses.
Essentially all cancers and indications are covered for Medicare patients. Click here for the pdf version of the table showing coverage for Medicare patients.
