Fusion Imaging for Cancer Indications - Medicare Advantage

This Humana Medicare Advantage coverage article endorses use of PET/CT and PET/MRI fusion imaging for a set of cancer indications following CMS NCD 220.6.17 and MAC LCD L35391 guidance. It specifies detailed medically necessary criteria for FDG PET, SSTR imaging (brain tumors and neuroendocrine tumors), amino-acid PET for suspected recurrent prostate cancer, PSMA PET for prostate cancer (including pre-Pluvicto staging), pulmonary nodule evaluation (nodules >=8 mm or part-solid with solid component >=8 mm), allows fusion of nonconcurrent studies when PET/CT or PET/MRI would be reasonable, and lists specific excluded fusion techniques and billing limitations (eg, CAD fusion, HDVI, MRI/CT, SPECT/MRI, PSMA for active surveillance).

"For guidance regarding FDG PET* (up to 3 scans), please refer to National Coverage Determination 220."

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