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

FDG PET (CPT 78608 with tracer A9552) is covered for select non-oncologic neurologic indications: to differentiate Alzheimer's disease from Fronto-temporal dementia in patients with documented cognitive decline ≥6 months who meet diagnostic criteria for both, and for pre-surgical evaluation of intractable seizures; FDG PET for MCI or early dementia is covered only within CMS‑approved clinical trials (report with Q0). Several coding and billing limitations apply — CPT 78609 and HCPCS A4641 are non-covered, A9597/A9598 are restricted, PET scans must be performed on FDA‑cleared/approved PET scanners, and claims must include supporting medical record documentation and appropriate CPT/HCPCS codes and modifiers.

"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 cognitiv..."