For dates of service on or after March 14, 1995, Medicare covers one PET scan for imaging of the perfusion of the heart using Rubidium 82 (Rb 82), provided that the following conditions are met:
• The PET is done at a PET imaging center with a PET scanner that has been approved by the FDA;
• The PET scan is a rest alone or rest with pharmacologic stress PET scan, used for noninvasive imaging of the perfusion of the heart for the diagnosis and management of patients with known or suspected coronary artery disease, using Rb 82; and
• Either the PET scan is used in place of, but not in addition to, a single photon emission computed tomography (SPECT) or the PET scan is used following a SPECT that was found inconclusive.
Expanded Coverage of PET Scan for Solitary Pulmonary Nodules (SPNs)
For dates of service on or after January 1, 1998, Medicare expanded PET scan coverage to include characterization of solitary pulmonary nodules (SPNs).
Expanded Coverage of PET Scans Effective for Services on or after July 1, 1999
Effective for services performed on or after July 1, 1999, Medicare expanded coverage of PET scans to include the evaluation of recurrent colorectal cancer in patients with rising levels of carinoembryonic antigen (CEA), for the staging of lymphoma (both Hodgkins and non-Hodgkins) when the PET scan substitutes for a gallium scan or lymphangiogram, and for the staging of recurrent melanoma prior to surgery, provided certain conditions are met. All three indications are covered only when using the radiopharmaceutical FDG- (2-[flourine-18]-fluoro-2-deoxy-D-glucose), and are further predicated on the legal availability of FDG for use in such scans.
Expanded Coverage of PET Scans Effective for Services on or After July 1, 2001