Radiologic Diagnostic Procedures – Medicare Advantage Medical Policy

Medicare Advantage covers PET scans for assessing myocardial viability in patients with known or suspected coronary artery disease, and CT scans are supported when they meet specific medical necessity criteria. Key requirements include compliance with Local Coverage Determinations and proper clinical documentation justifying the imaging, including previous non-invasive results. Limitations restrict coverage for routine screening in asymptomatic patients and require adherence to prior authorization protocols for certain services.

"PET scans are covered when used to assess myocardial viability in patients with known or suspected coronary artery disease."

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