Q9983, Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries
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
- For IPMN evaluation with FDG-PET/CT: documentation of imaging and clinical factors used in malignancy prediction (e.g., main pancreatic duct diameter, serum carcinoembryonic antigen [CEA] value, neutrophil-to-lymphocyte ratio [NLR], and PET accumulation/SUV when performed) because studies identified combinations of these as predictors.
- General: where PET is used to influence management (e.g., selection for surgery, targeted radioligand therapy such as Pluvicto), documentation should include prior imaging findings, treatment history, specific clinical question to be answered by PET, and how PET findings will impact treatment decisions (examples appear throughout the evidence summaries).
- No documentation requirements are specified in this excerpt.
- No explicit 'Documentation Requirements' section is present in this document chunk.
Key Coverage Criteria
- Evaluation of Coronary Artery Disease: PET scans using rubidium-82 (Rb-82) or N-13 ammonia done at rest or with pharmacological stress for non-invasive imaging of the perfusion of the heart for the diagnosis and management of members with known or suspected coronary artery disease when either (a) the PET scan is used in place of, but not in addition to, a single photon emission computed tomography (SPECT) in persons who meet medical necessity criteria for a cardiac SPECT (see CPB 0376) or (b) fo [...]
- Absolute quantitation of myocardial blood flow (AQMBF) as a medically necessary adjunct to cardiac PET when criteria for rest/stress perfusion for coronary artery disease are met.
- Assessment of Myocardial Viability: FDG-PET for the determination of myocardial viability prior to re-vascularization, either as a primary or initial diagnostic study or following an inconclusive SPECT.
- Cardiac Sarcoid: FDG-PET to identify and monitor response to therapy for established or strongly suspected cardiac sarcoid.
- Screening for paraneoplastic neurological syndromes
- Pancreatic adenocarcinoma
4 Active Policies
AETNA-CPB-0071, Positron Emission Tomography (PET)
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
EVICORE-HPLAN-CIGNA_MEDICARE-68F4526A04BF, 1199SEIU Radiology and Cardiology Claims Studio Code List - Effective 01/01/2026
Related Codes
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