2025 Head - Amyloid Addendum

This policy covers Amyloid PET Brain imaging (CPT® 78814 or 78811) for patients with mild cognitive impairment (MCI) or dementia when Alzheimer's disease (AD) is suspected — including those <65, amnesic AD onset ≥65, atypical presentations, cases with equivocal CSF biomarkers, to inform MCI prognosis, or to determine/monitor eligibility for amyloid‑targeting therapy. Coverage requires cognitive testing that raises suspicion for MCI/dementia due to AD and completion of evaluation including structural brain imaging prior to PET, and is limited to the listed CPT codes 78814 or 78811.

"Use for determining eligibility for amyloid-targeting therapy and monitoring response is subject to the additional criteria referenced in Imaging Related to Alzheimer's Treatment with Amyloid Reduc..."

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