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

Medicare covers FDG PET (CPT 78608 / HCPCS A9552) for non‑oncologic indications limited to: (1) differentiating Alzheimer's disease from frontotemporal dementia in patients with documented cognitive decline ≥6 months who meet diagnostic criteria for both, (2) intractable seizures when used for pre‑surgical localization, and (3) MCI/early dementia only within CMS‑approved clinical trials (report Q0). Coverage is conditional on meeting all NCD requirements, proper coding (TC/26 for components, Q0 for covered trials), use of appropriate tracer codes, performance at an FDA‑approved PET scanner, and sufficient medical record documentation to support the diagnosis and service.

"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 ..."