Multiple Imaging in Oncology

PET imaging in oncology is covered for assessment of therapeutic effect after curative or localized non-surgical therapies, evaluation of suspected recurrence/progression (new symptoms, physical findings, rising tumor markers, or equivocal imaging), restaging when disease extent will alter therapy, and for response evaluation when PET provides superior clinical information. PET should not be used in lieu of appropriate conventional imaging when those modalities can answer the clinical question, is limited in small lesions/areas of high physiologic activity or poorly FDG-avid tumors, and routine follow-up PET should be timed to avoid confounding by recent chemotherapy, radiation, marrow stimulants, or active infection; surveillance frequency guidance (e.g., every 6–12 months for ~5 years) and other timing limits are specified.

"PET is covered to assess therapeutic effect after completion of potentially curative therapy if additional or alternative therapy will be employed for residual or progressive disease."