Positron Emission Tomography (FDG) for Oncologic Conditions

CMS nationally covers FDG PET for oncologic uses as one initial study when cancer is biopsy-proven or strongly suspected and the treating physician determines PET is necessary to define tumor location/extent for treatment planning, with specific tumor-type coverage as summarized in the policy table. FDG PET is covered for staging distant metastasis in breast cancer, staging pre-treatment metastasis in cervical cancer after conventional imaging, and for melanoma excluding evaluation of regional lymph nodes; it is nationally non-covered for initial anti-tumor strategy in prostate adenocarcinoma and for breast diagnosis/axillary node staging and certain melanoma and cervical diagnosis uses. Up to three FDG PET scans are nationally covered for guiding subsequent management after completion of initial therapy; coverage beyond three scans is determined by local MACs, and the prior NOPR/CED prospective data collection requirement has been terminated effective June 11, 2013.