Positron Emission Tomography (PET)

Aetna covers cardiac PET (Rb‑82 or N‑13 ammonia) for myocardial perfusion when used instead of SPECT in members who meet SPECT medical‑necessity criteria or for post‑cardiac transplant assessment, AQMBF as an adjunct when perfusion criteria are met, FDG‑PET for myocardial viability prior to revascularization and for cardiac sarcoid, and FDG‑PET for diagnosis/staging/restaging/monitoring of specified malignancies when general and disease‑specific criteria are satisfied and the scan is necessary to guide management. PET is not covered for routine post‑treatment surveillance or for monitoring tumor response (except locally advanced/metastatic breast cancer when a therapy change is contemplated); SPECT after an inconclusive PET, biopsy after a negative PET for solitary pulmonary nodules, and repeat PET for SPN evaluation within 90 days of a prior negative PET are considered not medically necessary.

"R93."