September 24, 2018
BlueCross BlueShield of Tennessee has expanded Medicare coverage for Cardiac PET. The changes will go into effect later this year.
The expanded coverage policy includes the following:
- Positron emission tomography (PET) is considered medically necessary if the medical appropriateness criteria are met.
- Positron emission tomography (PET) for the diagnosis or evaluation of all other non-oncologic and/or noncardiac conditions/diseases is considered investigational.
- Positron emission tomography (PET) is considered medical appropriate if ANY ONE of the following are met: (1) Imaging of the adult or pediatric brain as part of preoperative planning for epilepsy surgery, (2) imaging of adult abdominal lymph node lesion if previous biopsy is negative or previous biopsy is inconclusive, and (3) imaging of a pediatric mediastinal mass prior to biopsy if lymphoma is suspected or there is evidence of tracheal compression.
SNMMI and the American Society of Nuclear Cardiology previously commended the proposal and recommended additional expansions. The full letter can be found here.