Aetna considers positron emission tomography (PET) medically necessary for the following cardiac indications:
Evaluation of Coronary Artery Disease:
PET scans using rubidium-82 (Rb-82) or N-13 ammonia done at rest or with pharmacological stress are considered medically necessary for noninvasive imaging of the perfusion of the heart for the diagnosis and management of members with known or suspected coronary artery disease, provided such scans meet either one of the two following criteria:
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 an inconclusive SPECT scan (i.e., the results of the SPECT are equivocal, technically uninterpretable, or discordant with a member's other clinical data).
In these cases, the PET scan must have been considered necessary in order to determine what medical or surgical intervention is required to treat the member.
Assessment of Myocardial Viability:
FDG-PET scans are considered medically necessary for the determination of myocardial viability prior to revascularization, either as a primary or initial diagnostic study or following an inconclusive SPECT. The greater specificity of PET makes a SPECT following an inconclusive PET not medically necessary.
The identification of members with partial loss of heart muscle movement or hibernating myocardium is important in selecting candidates with compromised ventricular function to determine appropriateness for revascularization. Diagnostic tests such as FDG-PET distinguish between dysfunctional but viable myocardial tissue and scar tissue in order to affect the management decisions in members with ischemic cardiomyopathy and left ventricular dysfunction.
Oncologic indications:
Aetna considers positron emission tomography (PET) medically necessary for the following oncologic indications, when the following general and disease-specific criteria for diagnosis, staging, restaging, or monitoring are met:
Solitary pulmonary nodules
Non-small cell lung carcinoma
Small cell lung carcinoma
Colorectal cancer
Lymphoma
Melanoma
Esophageal cancer
Gastric cancer
Gastrointestinal stromal tumors
Head and neck cancers (excluding cancers of the central nervous system)
Thyroid cancer (excluding metastatic thyroid cancer)
Breast cancer
Cervical cancer
Ovarian cancer
Testicular cancer
Multiple myeloma and plasmacytomas
Ewing sarcoma and osteosarcoma
Soft tissue sarcoma
Occult primary cancers.
PET-CT Fusion: The fusion of PET and CT imaging into a single system (PET/CT fusion) is considered medically necessary for any oncologic indication where PET scanning is considered medically necessary. PET-CT fusion is considered experimental and investigational for cardiac and neurologic indications; a PET scan without CT is adequate to evaluate the brain and myocardium (NIA, 2005).
General Criteria
Diagnosis: The PET results may assist in avoiding an invasive diagnostic procedure, or the PET results may assist in determining the optimal anatomic location to perform an invasive diagnostic procedure. In general, for most solid tumors, a tissue diagnosis is made prior to the performance of PET scanning. PET scans following a tissue diagnosis are performed for the purpose of staging, not diagnosis. Therefore, the use of PET in the diagnosis of lymphoma, esophageal carcinoma, colorectal cancers, and melanoma is rarely considered medically necessary.
Staging: PET is considered medically necessary in situations in which clinical management of the member would differ depending on the stage of the cancer identified and either:
the stage of the cancer remains in doubt after completion of a standard diagnostic workup, including conventional imaging (computed tomography, magnetic resonance imaging, or ultrasound); or
the use of PET would potentially replace one or more conventional imaging studies when it is expected that conventional study information is insufficient for the clinical management of the member.
Restaging: PET is considered medically necessary for restaging after completion of treatment for the purpose of detecting residual disease, for detecting suspected recurrence or to determine the extent of recurrence. Use of PET is also considered medically necessary if it could potentially replace one or more conventional imaging studies when it is expected that conventional study information is insufficient for the clinical management of the member.
Monitoring: PET for monitoring tumor response during the planned course of therapy is not considered medically necessary except for breast cancer. Restaging occurs only after a course of treatment is completed.
Disease-Specific Criteria
Characterization of Solitary Pulmonary Nodules (SPNs):
FDG-PET is considered medically necessary for the characterization of suspected SPNs when the general medical necessity criteria for oncologic indications (above) are met and the following conditions are met:
An indeterminate or possibly malignant lesion, more than 1 cm and not exceeding 4 cm in diameter, has been detected (usually by CT); and
A concurrent thoracic CT has been performed, which is necessary to ensure that the PET scan is properly coordinated with other diagnostic modalities.
The primary purpose of the PET scan of SPN should be to determine the likelihood of malignancy in order to plan the management of the member.
Note: A biopsy is not considered medically necessary in the case of a negative PET scan for SPNs, because the member is presumed not to have a malignant lesion, based upon the PET scan results.
Note: In cases of serial evaluation of SPNs using both CT and regional PET chest scanning, such PET scans are not considered medically necessary if repeated within 90 days following a previous negative PET scan.
Non-Small Cell Lung Carcinoma (NSCLC):
FDG-PET scans are considered medically necessary for diagnosis, staging, and restaging of non-small cell lung carcinoma (NSLC) when the general medical necessity criteria for oncologic indications (II. A. listed above) are met.
Small Cell Lung Carcinoma (SCLC):
FDG-PET scans are considered medically necessary for staging of persons with SCLC that has been determined to be clinical stage I (T 1-2, N0) after standard staging evaluation (including CT of the chest and upper abdomen, bone scan, and brain imaging).
Colorectal Cancer:
FDG-PET scans are considered medically necessary for diagnosis*, staging, and restaging of colorectal cancer when the general medical necessity criteria for oncologic indications (II. A. listed above) are met. According to CMS, new medical evidence supports the use of FDG-PET as a useful tool in determining the presence of hepatic/extrahepatic metastases in the primary staging of colorectal carcinoma, prior to selecting the treatment regimen. Use of FDG-PET is also supported in evaluating recurrent colorectal cancer where the member presents with clinical signs or symptoms of recurrence.
*Note: A diagnostic tissue sample is usually obtainable without PET localization. Therefore, PET for diagnosis of colorectal cancer is rarely considered medically necessary.
Lymphoma:
FDG-PET scans are considered medically necessary for the diagnosis*, staging and restaging of lymphoma when the general medical necessity criteria for oncologic indications (II. A. listed above) are met.
*Note: A diagnostic tissue sample is usually obtainable without PET localization. Therefore, PET for diagnosis of lymphoma is rarely considered medically necessary.
Melanoma:
FDG-PET scans are considered medically necessary for the diagnosis*, staging, and restaging of melanoma when the general medical necessity criteria for oncologic indications (II. A. listed above) are met. FDG-PET is considered experimental and investigational and not medically necessary for use in evaluating regional nodes in persons with melanoma.
*Note: A diagnostic tissue sample is usually obtainable without PET localization. Therefore, PET for diagnosis of melanoma is rarely considered medically necessary.
Esophageal Cancer:
FDG-PET is considered medically necessary for the diagnosis*, staging and re-staging of esophageal carcinoma when general medical necessity criteria for oncologic indications (II. A. listed above) are met. Medical evidence is present to support the use of FDG-PET in presurgical staging of esophageal cancer.
*Note: A diagnostic tissue sample is usually obtainable without PET localization. Therefore, PET for diagnosis of esophageal cancer is rarely considered medically necessary.
Gastric Cancer:
FDG-PET is considered medically necessary for diagnosis,* staging and restaging of gastric carcinoma when general medical necessity criteria for oncologic indications (II. A. listed above) are met. Consensus guidelines support the use of FDG-PET in the presurgical staging of gastric cancer.
*Note: A diagnostic tissue sample is usually obtainable without PET localization. Therefore, PET for diagnosis of gastric cancer is rarely considered medically necessary.
Gastrointestinal Stromal Tumors:
FDG-PET is considered medically necessary for diagnosis*, staging and restaging of gastrointestinal stromal tumors (GIST) when general medical necessity criteria for oncologic indications (II. A. listed above) are met. Consensus guidelines support the use of FDG-PET in the presurgical staging of GIST.
*Note: A diagnostic tissue sample is usually obtainable without PET localization. Therefore, PET for diagnosis of GIST is rarely considered medically necessary.
Head and Neck Cancers:
FDG-PET scans are considered medically necessary for the diagnosis, staging, and restaging of head and neck cancers (excluding cancers of the central nervous system (CNS)) when general medical necessity criteria for oncologic indications (II.A. listed above) are met. The head and neck cancers encompass a diverse set of malignancies of which the majority is squamous cell carcinomas. Persons with head and neck cancers may present with metastases to cervical lymph nodes but conventional forms of diagnostic imaging fail to identify the primary tumor. Persons with cancer of the head and neck are left with two options, either to have a neck dissection or to have radiation of both sides of the neck with random biopsies. PET scanning attempts to reveal the site of primary tumor to prevent adverse effects of random biopsies or unneeded radiation.
PET scans of the CNS are considered experimental and investigational.
Thyroid Cancer:
FDG-PET scans are considered medically necessary when general medical necessity criteria for oncologic indications (II. A. listed above) are met, for staging of thyroid cancer of follicular cell origin previously treated by thyroidectomy and radioiodine ablation with an elevated or rising serum thyroglobulin (Tg) greater than 10 ng/ml and negative I-131 whole body scintigraphy.
FDG-PET is considered not medically necessary for determining which members with metastatic thyroid cancer are at highest risk for death, because this information is for informational purposes only and has not been demonstrated to alter member management.
FDG-PET scans are considered experimental and investigational for other thyroid cancer indications, including:
Use for the initial staging of post-surgical thyroid cancer of cell types that concentrate I-131 poorly; or
Use of FDG-PET for re-staging of previously treated thyroid cancer of medullary cell origin in persons with an elevated serum calcitonin and negative standard imaging tests.
Breast Cancer:
FDG-PET scans are considered medically necessary for members with breast cancer for the following indications, where general medical necessity criteria for oncologic indications (II. A. listed above) are met:
Staging members with distant metastases or restaging members with locoregional recurrence or metastases; or
Monitoring tumor response to treatment for persons with locally advanced and metastatic breast cancer when a change in therapy is contemplated.
FDG-PET is considered experimental and investigational for the initial diagnosis of breast cancer and for the staging of axillary lymph nodes.
Cervical Cancer:
FDG-PET scans are considered medically necessary for the detection of pre-treatment metastases (staging) in women who are newly diagnosed with cervical cancer and have negative conventional imaging (CT or MRI), when general medical necessity criteria for oncologic indications (II. A. listed above) are met.
FDG-PET scans are considered experimental and investigational for the diagnosis and restaging of cervical cancer.
Ovarian Cancer:
FDG-PET scans are considered medically necessary for restaging (detecting recurrence) of previously treated women with a rising CA-125 level who have negative or equivocal conventional imaging (CT or MRI) when general medical necessity criteria for oncologic indications (II.A listed above) are met.
FDG-PET scans are considered experimental and investigational for diagnosis, staging, and monitoring of ovarian cancer.
Testicular Cancer:
FDG-PET scans are considered medically necessary for restaging (detecting recurrence) of testicular cancer in men with previously treated disease who have a residual mass with normal or persistently elevated serum markers (e.g., alpha fetoprotein or serum chorionic gonadotropin) when general medical necessity criteria for oncologic indications (II.A. listed above) are met.
FDG-PET scans are considered experimental and investigational for diagnosis, staging and monitoring of testicular cancer.
Multiple Myeloma and Plasmacytomas:
FDG-PET scans are considered medically necessary for evaluating suspected plasmacytomas (staging) in persons with multiple myeloma and for restaging of persons with solitary plasmacytomas.
Ewing Sarcoma and Osteosarcoma:
FDG-PET scans are considered medically necessary for staging and restaging of osteosarcoma and Ewing sarcoma family of tumors.
Soft Tissue Sarcoma:
FDG-PET scans are rarely medically necessary for soft tissue sarcomas. FDG-PET scans are considered medically necessary for staging prior to resection of an apparently solitary metastasis, or for grading unresectable lesions when the grade of the histopathological specimen is in doubt.
FDG-PET scans are considered experimental and investigational for restaging of soft tissue sarcomas.
Occult Primary:
FDG-PET is considered medically necessary for staging in carcinomas of unknown primary site in tumors of indeterminate histology where the primary site cannot be identified by endoscopy or other imaging studies (CT, MRI) and where locoregional therapy for a single site of disease is being considered.
FDG-PET scans are considered experimental and investigational for diagnosis or restaging of carcinomas of unknown primary.
Additional Experimental and Investigational Indications:
Aetna considers PET scans experimental and investigational for the evaluation of pancreatic cancer, central nervous system cancers, endometrial cancer, prostate cancer, kidney cancer, bladder cancer, hepatobiliary cancer, neuroendocrine tumors, jejunal adenocarcinoma, skin cancer, leukemia, neurofibromatosis, ileal carcinoma, malignant thymoma, Paget's disease (including extra-mammary Paget's disease), thymic carcinoma, vulvar cancer, gestational trophoblastic neoplasia, Langerhans cell histiocytosis, or for other oncologic indications not listed as medically necessary in this policy.
Neurologic Indications:
FDG-PET is considered medically necessary only for pre-surgical evaluation for the purpose of localization of a focus of refractory seizure activity.
Aetna considers PET scans experimental and investigational for Alzheimer disease, dementia, Parkinson's disease, Huntington disease, or for other neurologic indications not listed as medically necessary in this policy.
Other Indications:
FDG-PET is considered experimental and investigational for chronic osteomyelitis, infection of hip arthroplasty, fever of unknown origin, and other indications not listed as medically necessary in this policy.
Note: PET scans for routine screening of asymptomatic members are not considered medically necessary, regardless of the number and severity of risk factors applicable to the member.
Background
This policy is adapted from Center for Medicare and Medicaid Services (CMS) National Coverage Determinations regarding positron emission tomography (PET). The Center for Medicare and Medicaid Services Coverage Analysis Group has commissioned assessments of PET for a number of indications.
Positron emission tomography also known as positron emission transverse tomography (PETT), or positron emission coincident imaging (PECI), is a non-invasive diagnostic imaging procedure that assesses the level of metabolic activity and perfusion in various organ systems of the human body. A positron camera (tomograph) is used to produce cross-sectional tomographic images, which are obtained from positron emitting radioactive tracer substances (radiopharmaceuticals) such as 2-[F-18] fluoro-d-glucose (FDG) that are administered intravenously to the member.
Although PET scans using the radioactive glucose analog FDG have proven to be a highly accurate imaging test for diagnosing and staging a variety of non-urologic cancer types, its role in the management of prostate malignancies is still being defined. The use of PET scanning in the diagnosis and staging of prostate cancer is hampered by the generally low metabolic activity of most prostate tumors and their metastases. It has shown promise for staging and re-staging persons with advanced-stage disease and aggressive tumors suspected by a high tumor grade and high prostate-specific antigen velocity. Further investigations are needed to ascertain the eventual place of PET scans in prostate cancer.
An assessment by the Blue Cross and Blue Shield Association Technology Evaluation Center on PET for breast cancer (2003) stated that FDG-PET for evaluating breast cancer does not meet its criteria for initial staging of axillary lymph nodes, for detection of locoregional recurrence or distant metastasis/recurrence, or for evaluating response to treatment.
CMS has released a decision memorandum on PET for suspected dementia. Although CMS has announced limited coverage of PET to distinguish Alzheimer's disease from frontotemporal dementia when the distinction is uncertain and other criteria are met, the decision memorandum recognized that there is no available literature that directly evaluated the impact on patient outcomes of adding PET in patients with early dementia who have undergone standard evaluation who do not meet the criteria for Alzheimer disease due to variations in the onset, presentation, or clinical course (suggesting other neurodegenerative causes for the disorder such as frontotemporal dementia). In addition, CMS found no trials that examined the impact of PET in changing the management as a surrogate for evaluating PET impact on health outcomes in patients with this sort of difficult differential diagnosis. The assessment also recognized that there are no established cures for either Alzheimer disease or frontotemporal dementia. A paucity of medications are available for Alzheimer's disease, which have a limited ability to decrease the rate of cognitive decline when administered early in the course of the disease. CMS coverage determination was primarily based on the value of PET in providing information useful in “non-medical decision-making.” Aetna, however, does not consider non-medical decision-making a medically necessary indication for testing. Because of a lack of adequate evidence that PET scanning alters clinical management of such persons such that clinical outcomes are improved, Aetna considers PET scanning for differentiating Alzheimer disease from frontotemporal dementia experimental and investigational.
An assessment prepared for the California Technology Assessment Forum (CTAF) concluded that PET for Alzheimer's disease does not meet CTAF's criteria (Feldman, 2004). The assessment stated: “The critical question that remains unanswered by this and the other studies of PET in the evaluation of AD/dementia is: To what extent does PET improve diagnostic accuracy beyond what can be obtained with a thorough clinical evaluation? Given that the sensitivity of clinical criteria are reported to be about 80%-90%, it is difficult for any diagnostic test to significantly improve diagnostic accuracy. And given the fact that treatment of the most common non-AD dementias (e.g., Dementia of Lewy Bodies or vascular dementias) with cholinesterase inhibitor drugs is not likely to be harmful and in fact may be beneficial to these patients, it may be that an empirical approach of ruling out reversible causes of dementia and treating all others with cholinesterase inhibitor drugs is appropriate and cost effective.”
The assessment noted that the greatest promise of PET in Alzheimer disease is likely to be in improving a clinician's ability to identify at-risk patients and to offer them treatment before they are significantly affected by Alzheimer disease. Few studies, however, have enrolled patients with mild symptoms or mild cognitive impairment so it is unclear what role PET is destined to play in identifying this subgroup of patients most likely to benefit from current and emerging therapies for Alzheimer's disease.
A proposed decision memo for FDG-PET for infection and inflammation from the CMS (Phurrough et al, 2007) stated that there is insufficient evidence to conclude that FDG- PET for chronic osteomyelitis, infection of hip arthroplasty and fever of unknown origin are reasonable and necessary. Thus, CMS proposed to continue national non-coverage for these indications.
CPT Codes / HCPCS Codes / ICD-9 Codes
Cardiac indications:
CPT codes covered if selection criteria are met:
78459
78491
78492
Other CPT codes related to the CPB:
78464
78465
HCPCS codes covered if selection criteria are met:
A9526
Nitrogen N-13 ammonia, diagnostic, per study dose, up to 40 millicuries
A9552
Fluorodeoxyglucose F-18 FDG, diagnostic, per study dose, up to 45 millicuries
A9555
Rubidium Rb-82, diagnostic, per study dose, up to 60 millicuries
ICD-9 codes covered if selection criteria are met (not all-inclusive):
410.00 - 410.92
Acute myocardial infarction
411.0 - 411.89
Other acute and subacute forms of ischemic heart disease
412
Old myocardial infarction
413.0 - 413.9
Angina pectoris
426.2 - 426.6
Atrioventricular, bundle branch, and other heart block
427.31
Atrial fibrillation
428.0 - 428.9
Heart failure
Other ICD-9 codes related to the CPB:
414.00 - 414.07
Coronary atherosclerosis
V45.81
Aortocoronary bypass status
V45.82
Percutaneous transluminal coronary angioplasty status
Oncologic indications for PET and PET-CT Fusion:
CPT codes covered if selection criteria are met:
78608
78609
78811
78812
78813
78814
78815
78816
Other CPT codes related to the CPB:
32095
32100
32405
38500 - 38530
61534
61536
82378
HCPCS codes covered if selection criteria are met:
A9552
Fluorodeoxyglucose F-18 FDG, diagnostic, per study dose, up to 45 millicuries
G0235
PET imaging, any site, not otherwise specified
HCPCS codes not covered for indications listed in the CPB:
G0219
PET imaging whole body; melanoma for non-covered indications
G0252
PET imaging, full and partial-ring PET scanners only, for initial diagnosis of breast cancer and/ or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes)
Other HCPCS codes related to the CPB:
A4641
Radiopharmaceutical, diagnostic, not otherwise classified
ICD-9 codes covered if selection criteria are met:
Malignant neoplasm of lip, oral cavity, and pharynx, esophagus, stomach, colon, rectum, rectosigmoid junction, and anus, nasal cavities, middle ear, and accessory sinuses, mediastinum, respiratory system and other intrathoracic organs, bones of skull and face, mandible, connective tissue and other soft tissue, melanoma of skin, skin, breast, cervix uteri, ovary, testis, eye, thyroid gland, head, face, and neck
199.1
Other malignant neoplasm without specification of site [occult primary cancers]
200.00 - 202.48, 202.60 - 202.98
Malignant neoplasm of lymphatic and hematopoietic tissue
203.00 - 203.01
Multiple myeloma
230.0 - 230.4, 231.0 - 231.9, 233.0, 234.0
Carcinoma in situ lip, oral cavity, and pharynx, esophagus, stomach, colon, rectum, respiratory system, breast, and eye
235.0 - 235.1, 235.6 - 235.9
Neoplasm of uncertain behavior of major salivary glands, lip, oral cavity, and pharynx, larynx, trachea, bronchus, and lung, pleura, thymus, and mediastinum, and other and unspecified respiratory organs
345.00 - 345.91
Epilepsy and recurrent seizures [pre-surgical evaluation for localization of seizure focus]
492.8
Other emphysema
518.89
Other diseases of lung, not elsewhere classified
530.0
Achalasia and cardiospasm
530.89
Other specified disorders of esophagus
560.9
Unspecified intestinal obstruction
569.89
Other specified disorders of intestine
709.9
Unspecified disorder of skin and subcutaneous tissue
780.39
Other convulsions [pre-surgical evaluation for localization of seizure focus only]
784.2
Swelling, mass, or lump in head and neck
785.6
Enlargement of lymph nodes
793.1
Nonspecific abnormal findings on radiological and other examinations of lung field
Personal history of malignant neoplasm of esophagus, large intestine, rectum, rectosigmoid junction, and anus, trachea, bronchus and lung, larynx, nasal cavities, middle ear, and accessory sinuses, breast, stomach, cervix uteri, ovary, testis, lymphosarcoma and reticulosarcoma, Hodgkin's disease, bone, melanoma of skin, eye, and thyroid
ICD-9 codes not covered for indications listed in the CPB (not all-inclusive):
152.1
Malignant neoplasm of jejunum
152.2
Malignant neoplasm of ileum [ileal carcinoma]
155.0 - 159.9
Malignant neoplasm of liver and intrahepatic bile ducts, gallbladder and extrahepatic bile ducts, pancreas, retroperitoneum and peritoneum, and other and ill-defined sites within the digestive organs and peritoneum
164.0 - 164.1
Malignant neoplasm of thymus and heart
173.0 - 173.9
Malignant neoplasm of skin
176.0 - 179
Malignant neoplasm of Kaposi's sarcoma and uterus, part unspecified
181
Malignant neoplasm of placenta
182.0 - 182.8
Malignant neoplasm of body of uterus
184.0 - 184.9
Malignant neoplasm of other and unspecified female genital organs
185
Malignant neoplasm of prostate
187.1 - 189.9
Malignant neoplasm of penis and other male genital organs, bladder, and kidney and other and unspecified urinary organs
191.0 - 192.9
Malignant neoplasm of brain and other and unspecified parts of nervous system
194.0 - 194.9
Malignant neoplasm of other endocrine glands and related structures
196.9
Secondary and unspecified malignant neoplasm of lymph nodes, site unspecified
197.2 - 197.3
Secondary malignant neoplasm of pleura and other respiratory organs
197.4
Secondary malignant neoplasm of small intestine, including duodenum [ileal carcinoma]
197.6 - 197.7
Secondary malignant neoplasm of retroperitoneum and peritoneum, and liver, specified as secondary
198.0 - 198.5
Secondary malignant neoplasm of kidney, other urinary organs, skin, brain and spinal cord, other parts of nervous system, and bone and bone marrow
198.7
Secondary malignant neoplasm of adrenal gland
198.82
Secondary malignant neoplasm of genital organs
198.89
Secondary malignant neoplasm of other specified sites
Plasma cell leukemia and immunoproliferative neoplasms, lymphoid leukemia, myeloid leukemia, monocytic leukemia, and other specified leukemia
210.0 - 229.9
Benign neoplasms
230.5 - 230.9
Carcinoma in situ of anal canal, anus, unspecified, other and unspecified parts of intestine, liver and biliary system, and other and unspecified digestive organs
232.0 - 232.9
Carcinoma in situ of skin
233.32
Carcinoma in situ of vulva
234.8 - 234.9
Carcinoma in situ of other and unspecified sites
235.3 - 235.4
Neoplasm of uncertain behavior of liver and biliary passages, and retroperitoneum and peritoneum
235.9 - 237.9
Neoplasm of uncertain behavior of other and unspecified respiratory organs, genitourinary organs, and endocrine glands and nervous system
238.1
Neoplasm of uncertain behavior of connective and other soft tissue
238.3 - 238.79
Neoplasm of uncertain behavior of breast and other lymphatic and hematopoietic tissues
239.3 - 239.7
Neoplasm of uncertain behavior of breast, bladder, other genitourinary organs, brain, and endocrine glands and other parts of nervous system
239.9
Neoplasm of uncertain behavior, site unspecified
277.89
Other specified disorders of metabolism [langerhans cell histiocytosis]
290.0 - 319
Mental disorders
320 - 344.9, 346.00 - 389.9
Diseases of the nervous system and sense organs [except pre-surgical evaluation for localization of seizure focus]
Unspecified infective arthritis [infection of hip arthroplasty]
730.10 - 730.19
Chronic osteomyelitis
731.0
Osteitis deformans without mention of bone tumor [Paget's disease of bone]
780.01 - 780.09
Alteration of consciousness
780.1 - 780.2
Hallucinations and syncope and collapse
780.4
Dizziness and giddiness
780.6
Fever [fever of unknown origin (FUO)]
780.93
Memory loss
780.99
Other general symptoms
781.0 - 781.99
Symptoms involving nervous and musculoskeletal systems
793.0
Nonspecific abnormal findings on radiological and other examination of skull and head
793.2
Nonspecific abnormal findings on radiological and other examination of other intrathoracic organ
794.00 - 794.19
Nonspecific abnormal results of function studies of brain and central nervous system and peripheral nervous system and special senses
794.30 - 794.39
Nonspecific abnormal results of function studies, cardiovascular
996.66
Infection and inflammatory reaction due to internal joint prosthesis [infection of hip arthroplasty]
998.59
Other postoperative infection [infection of hip arthroplasty]
V10.00 - V10.02
Personal history of malignant neoplasm of gastrointestinal tract, unspecified
V10.07 - V10.09
Personal history of malignant neoplasm of liver and of gastrointestinal tract, other
V10.29
Personal history of malignant neoplasm of other respiratory and intrathoracic organs
V10.40
Personal history of malignant neoplasm of female genital organ, unspecified
V10.42
Personal history of malignant neoplasm of other parts of uterus
V10.44 - V10.46
Personal history of malignant neoplasm of other female genital organs, male genital organ, unspecified, and prostate
V10.48 - V10.60
Personal history of malignant neoplasm of epididymis, other male genital organs, urinary organs, and leukemia, unspecified
V10.62 - V10.69
Personal history of malignant neoplasm, myeloid, monocytic, and other leukemia
V10.79
Personal history of other lymphatic and hematopoietic neoplasms
V10.83
Personal history of other malignant neoplasm of skin
V10.85 - V10.86
Personal history of malignant neoplasm of brain and other parts of nervous system
V10.88 - V10.9
Personal history of malignant neoplasm of other endocrine glands and related structures, other, and unspecified sites
V43.64
Hip joint replaced by other means [infection of hip arthroplasty]
V70.0 - V82.9
Persons without reported diagnosis encountered during examination and investigation of individuals and populations
The above policy is based on the following references:
Flynn K, Adams E, Anderson D. Positron Emission Tomography. MTA94-001-02. Boston, MA: U.S. Department of Veterans Affairs, Veterans Health Administration, Management Decision and Research Center, Technology Assessment Program (VATAP); October 1996. Available at: http://www.va.gov/VATAP/. Accessed November 28, 2001.
Adams E, Flynn K. Positron emission tomography: Descriptive analysis of experience with PET in VA. A systematic review update of FDG-PET as a diagnostic test in cancer and Alzheimer's disease. Technology Assessment Program Report No. 10. Boston, MA: U. S. Department of Veterans Affairs, Veterans Health Administration, Management Decision and Research Center, Technology Assessment Program (VATAP); 1998. Available at: http://www.va.gov/VATAP/. Accessed November 28, 2001.
State of Minnesota, Health Technology Advisory Committee (HTAC). Positron emission tomography (PET) for oncologic applications. Technology Assessment. St. Paul, MN: HTAC; March 18, 1999.
Australian Department of Health and Ageing, Medical Services Advisory Committee (MSAC). Positron emission tomography. MSAC Application 1025. Canberra, ACT: MSAC; March 2000. Available at: http://www.health.gov.au/haf/msac. Accessed November 28, 2001.
Robert G, Milne R. Positron emission tomography: Establishing priorities for health technology assessment. Health Technol Assess. 1999;3(16):1-54. Available at: http://www.ncchta.org/fullmono/mon316.pdf. Accessed November 28, 2001.
Adams E, Asua J, Conde Olasagasti J, et al. Positron emission tomography: Experience with PET and synthesis of the evidence (INAHTA Joint Project). Boston, MA: U.S. Department of Veterans Affairs, Veterans Health Administration, Management Decision and Research Center, Technology Assessment Program (VATAP); 1999. Available at: http://www.inahta.org/. Accessed November 28, 2001.
Danish Centre for Evaluation and Health Technology Assessment (DACEHTA). Positron emission tomography (PET) with 18-F-fluorodeoxyglucose (FDG): A survey of the literature with regard to evidence for clinical use in oncology, cardiology and neurology. Copenhagen, Denmark: DACEHTA; 2001.
Danish Centre for Evaluation, Health Technology Assessment (DACEHTA). Paper concerning clinical PET-scanning using FDG - with focus on diagnosis of cancer. Copenhagen, Denmark: DACEHTA; 2001.
Deutsches Institut für Medizinische Dokumentation und Information (DIMDI). [Economic evaluation of positron-emission-tomography: a health economic HTA-report]. Cologne, Germany: DIMDI; 2001.
Health Technology Board for Scotland (HTBS). Health Technology Assessment Advice 2: Positron emission tomography (PET) imaging in cancer management. Glasgow, Scotland: HTBS; 2002.
Lozano JP, de la Blanca EBP. Tomografía de emisión de positrones: Síntesis de investigación sobre efectividad en diferentes indicaciones clínicas. Seville, Spain: Agencia de Evaluación de Tecnologías Sanitarias de Andalucía (AETSA); 2000.
Australian Department of Health and Ageing, Medical Services Advisory Committee (MSAC). Positron emission tomography - additional indications. MSAC Reference 10. Canberra, ACT: MSAC; 2001.
Institute for Clinical Systems Improvement (ICSI). PET scans for solitary pulmonary nodules, non-small cell lung cancer, recurrent colorectal cancer, lymphoma, and recurrent melanoma. Technology Assessment Report. Bloomington, MN: ICSI; 2001.
Rodríguez Garrido M, Asensio del Barrio C, Gómez Martnez M, et al. Positron emission tomography (PET) with 18FDG on clinical oncology. Informe de Evaluacion de Tecnologias Sanitarias No.30. IPE-01/30 (Public report). Madrid, Spain: Agencia de Evaluación Tecnologías Sanitarias (AETS); 2001.
Smiseth OA, Myhre ES, Aas M, et al. Positron emisjons tomografi (PET): Diagnostisk og klinisk nytteverdi. Oslo, Norway: Senter for Medisinsk Metodevurdering (SMM), SINTEF Unimed; 2002.
Center for Medicare and Medicaid Services (CMS). FDG Positron Emission Tomography (PET) Decision Memorandum #CAG-00065. Baltimore, MD: CMS; December 15, 2000. Available at: http://www.hcfa.gov/coverage/8b3-hh2.htm. Accessed November 28, 2001.
Center for Medicare and Medicaid Services (CMS). Positron emission tomography (PET or PETT). Medicare Coverage Issues Manual Sec. 50-36. Baltimore, MD: CMS; 2000. Available at: http://www.hcfa.gov/pubforms/06_cim/ci00.htm. Accessed November 28, 2001.
Blue Cross Blue Shield Association (BCBSA), Technology Evaluation Center (TEC). FDG positron emission tomography for evaluating breast cancer. TEC Assessment Program. Chicago, IL: BCBSA, November 2003;18(14). Available at: http://www.bcbs.com/tec/vol18/18_14.html. Accessed February 6, 2004.
Fédération Nationale Des Centers De Lutte Contre Le Cancer (FNCLCC). Standards, options et recommandations pour l'utilisation de la tomographie par émission de positons au [18F]-FDG (TEP-FDG) en cancérologie. Paris, France: FNCLCC; 2002.
Comite d'Evaluation et de Diffusion des Innovations Technologiques (CEDIT). Positron emission tomography. 01.01. Paris, France: CEDIT; 2001.
Dussault FP, Nguyen VH, Rachet F. Positron emission tomography in Quebec. AETMIS 01-3 RE. Montreal, QC: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS); 2002.
Institute for Clinical Evaluative Sciences (ICES). Health Technology Assessment of Positron Emission Tomography (PET) in Oncology. A Systemic Review. Toronto, ON; ICES; May 1, 2003. Available at: http://www.ices.on.ca/. Accessed July 8, 2003.
Center for Medicare and Medicaid Services (CMS). Positron emission tomography (PET) scanner technology. Decision Memorandum #CAG-00090A. Baltimore, MD: CMS; June 29, 2001. Available at: http://www.hcfa.gov/coverage/download/8b3-oo1.rtf. Accessed November 28, 2001.
Center for Medicare and Medicaid Services (CMS). FDG positron emission tomography - breast cancer. Decision Memorandum. #CAG-00094A. Baltimore, MD: CMS; February 27, 2002. Available at: http://www.hcfa.gov/coverage/download/8b3-vv.pdf. Accessed April 22, 2002.
Center for Medicare and Medicaid Services (CMS). FDG positron emission tomography for myocardial viability. Decision Memorandum #CAG-00098N. Baltimore, MD: CMS; February 20, 2002. Available at: http://www.hcfa.gov/coverage/8b3-ddd2.htm. Accessed April 22, 2002.
Shvarts O, Han KR, Seltzer M, et al. Positron emission tomography in urologic oncology. Cancer Control. 2002;9(4):335-342.
Reinhardt MJ, Matthies A, Biersack HJ. PET-imaging in tumors of the reproductive tract. Q J Nucl Med. 2002;46(2):105-112.
Matchar DB, Kulasingam SL, McCrory DC, et al., and the Duke Evidence-Based Practice Center. Use of positron emission tomography and other neuroimaging techniques in the diagnosis and management of Alzheimer's disease and dementia. Technology Assessment. Prepared for the Agency for Healthcare Research and Quality, Contract No.290-97-0014, Task Order 7. Baltimore, MD: Center for Medicare and Medicaid Services; December 14, 2001. Available at: http://cms.hhs.gov/coverage/download/8b3-ww3.pdf. Accessed April 4, 2003.
Balk E, Lau J, and the New England Medical Center Evidence-Based Practice Center. Systemic review of positron emission tomography for the follow-up of treated thyroid cancer. Technology Assessment. Prepared for the Agency for Healthcare Research and Quality, Contract No. 270-97-0019. Baltimore, MD: Center for Medicare and Medicaid Services: April 10, 2002. Available at: http://cms.hhs.gov/ncdr/techasmt.asp. Accessed April 4, 2003.
Ioannidis JPA, Lau J, and the New England Medical Center Evidence-Based Practice Center. FDG-PET for the diagnosis and management of soft tissue sarcoma. Technology Assessment. Prepared for the Agency for Healthcare Research and Quality, Contract No. 290-97-0019. Baltimore, MD: Center for Medicare and Medicaid Services; April 5, 2002. Available at: http://cms.hhs.gov/ncdr/techasmt.asp. Accessed April 4, 2003.
Center for Medicare and Medicaid Services (CMS). Positron emission tomography (FDG) for soft tissue sarcoma (STS). Decision Memorandum #CAG-00099N. Baltimore, MD: CMS; April 16, 2003. Available at: http://cms.hhs.gov/ncdr/memo.asp?id=69. Accessed May 29, 2003.
Center for Medicare and Medicaid Services (CMS). Positron emission tomography (FDG) for Alzheimer's disease/dementia. Decision Memorandum #CAG-00088N. Baltimore, MD: CMS; April 16, 2003. Available at: http://cms.hhs.gov/ncdr/memo.asp?id=64. Accessed May 29, 2003.
Center for Medicare and Medicaid Services (CMS). Positron emission tomography (N-13 Ammonia) for myocardial perfusion. Decision Memorandum #CAG-00165N. Baltimore, MD: CMS; April 16, 2003. Available at: http://cms.hhs.gov/ncdr/memo.asp?id=66. Accessed May 29, 2003.
BlueCross BlueShield Association (BCBSA), Technology Evaluation Center (TEC). FDG PET to manage patients with an occult primary carcinoma and metastasis outside the cervical lymph nodes. TEC Assessment Program. Chicago, IL: BCBSA; 2002;17(14).
BlueCross BlueShield Association (BCBSA), Technology Evaluation Center (TEC). FDG positron emission tomography for evaluating esophageal cancer. TEC Assessment Program. Chicago, IL: BCBSA; 2001;16(21).
Comite d'Evaluation et de Diffusion des Innovations Technologiques (CEDIT). CT-PET scanners - systematic review, expert panel. Paris, France: CEDIT; 2002.
Morland B. Positron emission tomography (PET) - diagnostic and clinical use. SMM-Report 6/2003. Oslo, Norway: The Norwegian Centre for Health Technology Assessment (SMM); 2003.
Silvestri GA, Tanoue LT, Margolis ML, et al. The noninvasive staging of non-small cell lung cancer: The guidelines. Chest. 2003;123(1 Suppl):147S-156S.
Hricak H, Schoder H, Pucar D, e al. Advances in imaging in the postoperative patient with a rising prostate-specific antigen level. Semin Oncol. 2003;30(5):616-634.
Belhocine T. An appraisal of 18F-FDG PET imaging in post-therapy surveillance of uterine cancers: Clinical evidence and a research proposal. Int J Gynecol Cancer. 2003;13(2):228-233.
Matchar DB, Kulasingam SL, Havrilesky L, et al. and the Duke Center for Clinical Health Policy Research and Evidence Practice Center. Positron emission testing for six cancers (brain, cervical, small cell lung, ovarian, pancreatic and testicular). Technology Assessment. Prepared for the Agency for Healthcare Research and Quality (AHRQ). Rockville, MD: AHRQ; February 12, 2004. Available at: http://www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=92. Accessed February 12, 2004.
Matchar D, Kulasingam S, Huntington B, et al. and the Duke Center for Clinical Health Policy Research and Evidence Practice Center. Positron emission tomography, single photon emission computed tomography, computed tomography, functional magnetic resonance imaging, and magnetic resonance spectroscopy for the diagnosis and management of Alzheimer's disease. Technology Assessment. Prepared for the Agency for Healthcare Research and Quality (AHRQ). Rockville, MD: AHRQ; April 2004. Available at: http://www.cms.hhs.gov/coverage/download/id104b.pdf. Accessed September 17, 2004.
Albert M, DeCarli C, DeKosky S, et al. and the Alzheimer's Association Neuroimaging Workgroup. The use of MRI and PET for clinical diagnosis of dementia & investigation of cognitive impairment. A Consensus Report. Chicago, IL: Alzheimer's Association; April 2004. Available at: http://www.alz.org/Research/Papers/Imaging_consensus_report.pdf. Accessed September 17, 2004.
National Institutes of Health (NIH), National Institute on Aging (NIA). Neuroimaging in the diagnosis of Alzheimer's disease and dementia. Expert panel convened by the Neuroscience and Neuropsychology of Aging Program, National Institute on Aging (NIA), Department of Health and Human Services (DHHS). Bethesda, MD: NIH; April 5, 2004. Available at: http://www.cms.hhs.gov/coverage/download/id104d.pdf. Accessed September 17, 2004.
Center for Medicare and Medicaid Services (CMS). Positron emission tomography (FDG) and other neuroimaging devices for suspected dementia. Decision Memorandum #CAG-00088R. Baltimore, MD: CMS; September 16, 2004. Available at: https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=104. Accessed September 17, 2004.
Bristow RE, del Carmen MG, Pannu HK, et al. Clinically occult recurrent ovarian cancer: Patient selection for secondary cytoreductive surgery using combined PET/CT. Gynecol Oncol. 2003;90(3):519-528.
Lardinois D, Weder W, Hany TF, et al. Staging of non-small-cell lung cancer with integrated positron emission tomography and computed tomography. N Eng J Med. 2003;348(25):2500-2507.
Ontario Ministry of Health and Long-Term Care, Medical Advisory Secretariat, Ontario Health Technology Advisory Committee. Indication for positron emission tomography [PET] imaging of a single pulmonary nodule [SPN]. OHTAC Recommendation. Toronto, ON: OHTAC; May 12, 2004.
Schoder H, Larson SM, Yeung HW. PET/CT in oncology: Integration into clinical management of lymphoma, melanoma, and gastrointestinal malignancies. J Nucl Med. 2004;45 Suppl 1:72S-81S.
Schoder H, Yeung HW, Gonen M, et al. Head and neck cancer: Clinical usefulness and accuracy of PET/CT image fusion. Radiology. 2004;31(1):65-72.
Center for Medicare and Medicaid Services (CMS). Decision memo for positron emission tomography (FDG) for brain, cervical, ovarian, pancreatic, small cell lung, and testicular cancers (CAG-00181N). Medicare Coverage Database. Baltimore, MD: CMS; January 28, 2005. Available at: http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=92. Accessed October 17, 2006.
Schillaci O, Simonetti G. Fusion imaging in nuclear medicine - applications of dual-modality systems in oncology. Cancer Biother Radiopharm. 2004;19(1):1-10.
Dehn TG. PET scan codes and coverage. A discussion 'white paper' prepared for NIA clients. Hackensack, NJ: National Imaging Associates, Inc. (NIA); February 2005.
Feldman MD. Positron emission tomography (PET) for the evaluation of Alzheimer's disease/dementia. Technology Assessment. San Francisco, CA: California Technology Assessment Forum; February 11, 2004. Available at: http://ctaf.org/ass/viewfull.ctaf?id=6071375853. Accessed March 4, 2004.
Tice JA. Positron emission tomography (PET) for the evaluation of breast lesions for diagnosis of breast cancer. Technology Assessment. San Francisco, CA: Callifornia Technology Assessment Forum; June 11, 2003. Available at: http://ctaf.org/ass/viewfull.ctaf?id=3287534156. Accessed March 4, 2004.
Tice JA. Positron emission tomography (PET) for the evaluation of breast lesions for staging axillary lymph nodes. Technology Assessment. San Francisco, CA: California Technology Assessment Forum; June 11, 2003. Available at: http://ctaf.org/ass/viewfull.ctaf?id=3287534157. Accessed March 4, 2004.
Morland B. Positron emission tomography (PET) - diagnostic and clinical use. Oslo, Norway: Norwegian Centre for Health Technology Assessment (SMM); 2003.
Canadian Coordinating Office for Health Technology Assessment (CCOHTA). PET scanner update. Health Technology Update. Ottawa, ON: CCOHTA; Fall 2005.
Wechalekar K, Sharma B, Cook G. PET/CT in oncology--a major advance. Clin Radiol. 2005;60(11):1143-1155.
Facey K, Bradbury I, Laking G, Payne E. Positron emission tomography (PET) imaging in cancer management. Ultra Rapid Review. Health Technology Assessment. National Health Service (NHS) Research & Development (R&D) Programme. Southampton, UK: NHS R&D Programme; July 2004.
Mosconi L. Brain glucose metabolism in the early and specific diagnosis of Alzheimer's disease. FDG-PET studies in MCI and AD. Eur J Nucl Med Mol Imaging. 2005;32(4):486-510.
Fanti S, Franchi R, Battista G, et al. PET and PET-CT. State of the art and future prospects. Radiol Med (Torino). 2005;110(1-2):1-15.
Medical Services Advisory Committee (MSAC). Positron emission tomography (PET) for epilepsy. MSAC Reference 26. Canberra, ACT: MSAC; 2004.
Pichon Riviere A, Augustovski F, Cernadas C, et al. Positron emission tomography (PET): Diagnostic usefulness and indications [summary]. Report IRR No. 6. Buenos Aires, Argentina: Institute for Clinical Effectiveness and Health Policy (IECS); 2003.
Rodriguez Garrido M, Asensio del Barrio C. PET-CT: Indications, systematic review and meta-analysis IPE-04/41 (Public report) [summary]. Informe de Evaluacion de Tecnologias Sanitarias No. 41. Madrid, Spain: Agencia de Evaluacion de Tecnologias Sanitarias (AETS); 2004.
Mundy L, Merlin T, Hodgkinson B, et al. Combined CT and PET scanner for carcinomas. Horizon Scanning Report. Adelaide, SA: Adelaide Health Technology Assessment (AHTA) on behalf of National Horizon Scanning Unit (HealthPACT and MSAC); February 2004.
Haute Autorite de sante/French National Authority for Health (HAS). Combined positron emission tomography/computed tomography [summary]. Saint-Denis La Plaine, France: HAS; 2005.
Quek ML, Simma-Chiang V, Stein JP, et al. Postchemotherapy residual masses in advanced seminoma: Current management and outcomes. Expert Rev Anticancer Ther. 2005;5(5):869-874.
Becherer A, De Santis M, Karanikas G, et al. FDG PET is superior to CT in the prediction of viable tumour in post-chemotherapy seminoma residuals. Eur J Radiol. 2005;54(2):284-288.
Karapetis CS, Strickland AH, Yip D, et al. Use of fluorodeoxyglucose positron emission tomography scans in patients with advanced germ cell tumour following chemotherapy: Single-centre experience with long-term follow up. Intern Med J. 2003;33(9-10):427-435.
Flechon A, Bompas E, Biron P, Droz JP. Management of post-chemotherapy residual masses in advanced seminoma. J Urol. 2002;168(5):1975-1979.
De Santis M, Bokemeyer C, Becherer A, et al. Predictive impact of 2-18fluoro-2-deoxy-D-glucose positron emission tomography for residual postchemotherapy masses in patients with bulky seminoma. J Clin Oncol. 2001;19(17):3740-3744.
Hain SF, O'Doherty MJ, Timothy AR, et al. Fluorodeoxyglucose positron emission tomography in the evaluation of germ cell tumours at relapse. Br J Cancer. 2000;83(7):863-869.
Ganjoo KN, Chan RJ, Sharma M, Einhorn LH. Positron emission tomography scans in the evaluation of postchemotherapy residual masses in patients with seminoma. J Clin Oncol. 1999;17(11):3457-3460.
Kurosaki H, Oriuchi N, Okazaki A, et al. Prognostic value of FDG-PET in patients with ovarian carcinoma following surgical treatment. Ann Nucl Med. 2006;20(3):171-174.
Murakami M, Miyamoto T, Iida T, et al. Whole-body positron emission tomography and tumor marker CA125 for detection of recurrence in epithelial ovarian cancer. Int J Gynecol Cancer. 2006;16 Suppl 1:99-107.
Takekuma M, Maeda M, Ozawa T, et al. Positron emission tomography with 18F-fluoro-2-deoxyglucose for the detection of recurrent ovarian cancer. Int J Clin Oncol. 2005;10(3):177-181.
Chang WC, Hung YC, Kao CH, et al. Usefulness of whole body positron emission tomography (PET) with 18F-fluoro-2-deoxyglucose (FDG) to detect recurrent ovarian cancer based on asymptomatically elevated serum levels of tumor marker. Neoplasma. 2002;49(5):329-333.
Cho SM, Ha HK, Byun JY, et al. Usefulness of FDG PET for assessment of early recurrent epithelial ovarian cancer. AJR Am J Roentgenol. 2002;179(2):391-395.
Torizuka T, Nobezawa S, Kanno T, et al, Ovarian cancer recurrence: Role of whole-body positron emission tomography using 2-[fluorine-18]-fluoro-2-deoxy- D-glucose. Eur J Nucl Med Mol Imaging. 2002;29(6):797-803.
Zimny M, Siggelkow W, Schroder W, et al. 2-[Fluorine-18]-fluoro-2-deoxy-d-glucose positron emission tomography in the diagnosis of recurrent ovarian cancer. Gynecol Oncol. 2001;83(2):310-315.
Lema LV, Garcia-Caeiro A. Diagnostic accuracy and clinical usefulness of Positron Emission Tomography (PET) in breast and ovarian cancer recurrence (HTA report) [summary]. INF2004/01. Santiago de Compostela, Spain: Galician Agency for Health Technology Assessment (AVALIA-T); 2004.
Rodriguez Garrido M, Asensio del Barrio C, Alcazar Alcazar R. PET-CT: indications and counterindications. IPE-05/49 (Public report) [summary]. Informe de Evaluacion de Tecnologias Sanitarias No. 49. Madrid, Spain: Agencia de Evaluacion de tecnologias Sanitarias (AETS); 2006.
Belgian Health Care Knowledge Centre (KCE). HTA positron emission tomography imaging in Belgium. KCE Reports Vol. 22B. Ref. D2005/10.273/31. Brussels, Belgium: KCE; 2005. Available at: http://kce.fgov.be/Download.aspx?ID=277. Accessed January 26, 2007.
Mann GN, Link JM, Pham P, et al. [11C]metahydroxyephedrine and [18F]fluorodeoxyglucose positron emission tomography improve clinical decision making in suspected pheochromocytoma. Ann Surg Oncol. 2006;13(2):187-197.
Nanni C, Zamagni E, Farsad M, et al. Role of 18F-FDG PET/CT in the assessment of bone involvement in newly diagnosed multiple myeloma: Preliminary results. Eur J Nucl Med Mol Imaging. 2006;33(5):525-531.
Zamagni E, Nanni C, Patriarca F, et al. A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma. Haematologica. 2007;92(1):50-55.
Agency for Health Technology Assessment in Poland (AHTAPol). Cost-effectiveness analysis of PET-CT positron emission tomography and the diagnostic technologies financed from public sources in oncological diagnostics in Poland. Health Technology Assessment Report. Warsaw, Poland: AHTAPol; 2007. Available at: http://aotm.eu/pliki/bad/hta/PET-CT_clinical_full_ENG.pdf. Accessed June 20, 2007.
Aoyagi S, Sato-Matsumura KC, Shimizu H. Staging and assessment of lymph node involvement by 18F-fluorodeoxyglucose-positron emission tomography in invasive extra-mammary Paget's disease. Dermatol Surg. 2005;31(5):595-598.
Dhillon T, Palmieri C, Sebire NJ, et al. Value of whole body 18FDG-PET to identify the active site of gestational trophoblastic neoplasia. J Reprod Med. 2006;51(11):879-887.
Chang TC, Yen TC, Li YT, et al. The role of 18F-fluorodeoxyglucose positron emission tomography in gestational trophoblastic tumours: A pilot study. Eur J Nucl Med Mol Imaging. 2006;33(2):156-163.
Yen TC, Lai CH. Positron emission tomography in gynecologic cancer. Semin Nucl Med. 2006;36(1):93-104.
Bateman RJ, Eidelberg D. Testing a test for Alzheimer disease. Neurology. 2007;68(7):482-483.
Sloka JS, Hollett PD, Mathews M. A quantitative review of the use of FDG-PET in the axillary staging of breast cancer. Med Sci Monit. 2007;13(3):RA37-RA46.
Bouchelouche K, Oehr P. Positron emission tomography and positron emission tomography / computerized tomography of urological malignancies: An update review. J Urol. 2008;179(1):34-45.
Phurrough SE, Jacques L, Caplan S, Feinglass SR. Proposed decision memo for positron emission tomography (FDG) for infection and inflammation (CAG-00382N). Baltimore, MD: Centers for Medicare & Medicaid Services; December 20, 2007. Available at: https://www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp?id=207. Accessed January 3, 2008.
Facey K, Bradbury I, Laking G, Payne E. Overview of the clinical effectiveness of positron emission tomography imaging in selected cancers. Health Technol Assess. 2007;11(44):1-304.
Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
Close Window
