FDG PET/CT COVERAGE

Medicare has approved 559 diagnosis codes for and 26 FDG metabolic brain codes using fluorodeoxyglucose (FDG) for scanning purposes. To help visualize coverage areas as they relate to CPT codes, NCPIC wanted to illustrate the anatomy coverage and corresponding CPT code.

Approved Code: 78815

Tracer used: A9552 (FDG)

Coverage: skull base to mid-thigh.

Clinical Use: Most commonly ordered PET exam.

Note: Approved for initial staging and restaging of oncology indications.

Approved Code: 78608

Tracer used: A9552 (FDG)

Coverage: brain

Clinical Use: FDG for brain metabolic evaluation of Alzheimer’s, Picks or other dementias.

Note: If attempting to order a PET for mild dementia and potential therapy treatment (leqembi®) please order an amyloid PET versus a FDG brain.

Approved Code: 78816

Tracer used: A9552 (FDG)

Coverage: top of head to bottom of feet.

Clinical Use: Multiple Myeloma, Melanoma, Osteosarcoma, Cutaneous t-cell lymphoma (or other appropriate lymphomas).

Note: Approved for initial staging and restaging of oncology indications.