Updated eviCore Oncology Guidelines Cover Only FDG for PET Imaging
October 7, 2016
What is the news?
- eviCore, one of the leading medical benefits management companies in the U.S., has updated its coding recommendations for PET imaging in oncology and imaging in prostate cancer.
- Per this decision, eviCore will cover only FDG – not fluciclovine, choline, or Ga DOTATATE – for oncologic PET imaging.
- The draft guidelines state that “PET imaging (including 18F-FDG, 18F-NaF, and 11C-Choline) is considered investigational and experimental for all indications for prostate cancer at this time.”
Why does it matter?
- eviCore processes 12 million claims annually.
- This decision could deprive patients of access to FDA-approved, commercially available, and highly valuable PET diagnostic imaging procedures that may detect and localize cancers more effectively than current modalities such as CT and/or MRI.
What is SNMMI doing?
- SNMMI is closely monitoring the issue and will keep members informed of any new developments.