Does G0235 require prior authorization?

Yes, G0235 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for G0235?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

Verity

`G0235`, Pet imaging, any site, not otherwise specified

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Medical records must be maintained and available upon request, be legible, include complete patient identification and dates of service, and contain the legible signature of the physician or non‑physician practitioner responsible for care.
The submitted medical record must support the selected ICD‑10‑CM diagnosis code(s) and the CPT/HCPCS code billed must accurately describe the service performed.
When FDG PET is performed in the context of a CMS‑approved practical clinical trial using a specific protocol, the claim should be reported with modifier Q0.
When only the technical or professional component is performed, report the PET procedure with modifier TC (technical) or 26 (professional), respectively.
Providers must be able to produce, upon request, documentation of FDA approval/clearance of the PET scanner used (no approval letter required with the claim).
When PET and diagnostic CT scans are performed: (a) PET and separately obtained diagnostic CT on the same date but in a separate session may be coded individually; (b) a hybrid PET/CT plus an additional diagnostic CT obtained non‑concurrently may be coded separately; and (c) the CT component of a PET/CT used only for attenuation correction/localization is not a diagnostic CT and should not be billed as such.

Key Coverage Criteria

FDG PET (CPT 78608 / HCPCS A9552) is covered to differentiate Alzheimer's disease (AD) from frontotemporal dementia (FTD) in patients with a recent dementia diagnosis who have documented cognitive decline for at least 6 months and who meet diagnostic criteria for both AD and FTD.
FDG PET is covered for patients with mild cognitive impairment (MCI) or early dementia only when performed as part of a CMS‑approved practical clinical trial (coverage with evidence development).
FDG PET (CPT 78608) is covered for intractable seizures only when used as part of a pre‑surgical evaluation for seizure focus localization.
FDG PET (CPT 78608 / tracer A9552) is covered to differentiate Alzheimer's disease (AD) from Fronto-temporal dementia (FTD) in patients recently diagnosed with dementia who have documented cognitive decline of at least 6 months and who meet diagnostic criteria for both AD and FTD.
FDG PET (CPT 78608) is covered for intractable seizures only when used as part of a pre-surgical evaluation.
FDG PET is covered for patients with mild cognitive impairment (MCI) or early dementia only when performed within a CMS-approved practical clinical trial following an approved protocol (report claims with Q0 modifier).

18 Active Policies

CGS-L39521, Positron Emission Tomography (PET) Scan for Inflammation and Infection

J15

A59049, Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions

A53134, Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions

CARELON-imaging-of-the-brain-2024-10-20, Imaging of the Brain

CARELON-imaging-of-the-brain-2025-11-15-updated-2026-01-01, Imaging of the Brain

CARELON-imaging-of-the-extremities-2024-10-20, Imaging of the Extremities

CARELON-imaging-of-the-extremities-2025-11-15, Imaging of the Extremities

CARELON-imaging-of-the-spine-2024-10-20, Imaging of the Spine

CARELON-imaging-of-the-spine-2025-11-15, Imaging of the Spine

A59318, Billing and Coding: Positron Emission Tomography (PET) Scan for Inflammation and Infection

EVICORE-HPLAN-CIGNA-1815296EE67F, Cigna Comprehensive Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA-3623642AC89E, Cigna Commercial Radiology Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA_MEDICARE-68F4526A04BF, 1199SEIU Radiology and Cardiology Claims Studio Code List - Effective 01/01/2026

EVICORE-HPLAN-CIGNA_MEDICARE-4510B5F98EEE, 1199SEIU Radiology and Cardiology PA Code List - Effective 01/01/2026

EVICORE-HPLAN-EMBLEM_GHI-47D7797307C9, GHI/Emblem Non-City of New York & Medicare Radiology and Cardiology Code List - Effective 01/01/2026

EVICORE-HPLAN-EOCCO-F43FD04E5F71, EOCCO Cardiology & Radiology Code List - Effective 01/01/2026

EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-A85DF30B790E, Health Partners Plans Cardiology, Radiology, and Ultrasound Code List – Effective 01/01/2026

EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-CFF312B0BB7B, Health Partners Plans Cardiology, Radiology, and Ultrasound Code List – Effective 07/01/2025

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G0235, Pet imaging, any site, not otherwise specified