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ONCOLOGY INDICATIONS
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CPT CODES
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| Diagnosis, Staging, Restaging |
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Diagnosis: |
| Colorectal Cancer |
78812 |
- PET result may assist in avoiding an invasive diagnostic procedure or
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-PET results may assist in determining the optimal anatomical location to perform an invasive diagnostic procedure |
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Staging: |
| Esophageal Cancer |
78812 |
-The stage of the cancer is in doubt after the completion of a standard diagnostic workup including conventional imaging or |
| |
|
-PET 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 patient |
Head and Neck Cancer
(Excludes CNS and thyroid cancers)
|
78812 |
-The clinical management of the patient will differ depending on the stage of the cancer identified |
| |
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Restaging: |
| Lymphoma |
78812 |
-After completion of treatment for the purpose of detecting residual disease or |
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-For detecting suspected recurrence or metastasis or |
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-To determine the extent of known recurrence or |
| Melanoma (Not covered for the evaluation of regional nodes) |
78813 |
-PET 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 patient |
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-Restaging applies to testing after a course of treatment is completed |
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| Staging, Restaging, Monitoring |
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-Staging patients with distant metastasis or restaging patients with locoregional recurrence or metastasis as an adjunct to other imaging modalities |
| Breast Cancer |
78812 |
-Monitoring tumor response to treatment for locally advanced and metastatic breast cancer when a change in therapy is anticipated as an adjunct to other imaging modalities |
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--Limitation: Diagnosis of breast cancer and initial staging of axillary lymph nodes not covered by Medicare |
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| Restaging |
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| Thyroid Cancer |
78812 |
-Restaging of recurrent or residual thyroid cancers of follicular cell origin that have been previously treated by thyroidectomy and radioiodine ablation and have serum thyroglobulin >10ng/ ml and a negative I-131 whole body scan |
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| Staging |
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| Cervical Cancer |
78812 |
-The detection of metastasis during the pre-treatment management phase (i.e. staging) in patients with newly diagnosed and locally advanced cervical cancer with no extra-pelvic matastsis on conventional imaging (CT, MRI) |
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| Characterization |
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-Evidence of the initial detection of a primary lung tumor by CT |
| Single Pulmonary Nodules (SPNs) |
78812 |
-CT results indicate an ideterminate or possibly malignant lesion not exceeding 4cm in diameter |
| |
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-Frequency Limitation: Serial evaluation of SPN's with PET not covered if repeated within 90 days following a negative PET scan |
|
NEUROLOGY INDICATIONS
|
CPT CODES
|
|
| Refractory Seizures |
78608 |
-Pre-surgical evaluation for the purpose of localization of a focus of refractory seizure activity |
| |
|
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| Alzheimer's Disease |
78608 |
-Differential diagnosis of fronto-temporal dimentia (FTD) and Alzheimer's diease (AD) under specific requirements (please refer to separate coverage criteria guide for AD) |
| |
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| Brain Imaging, PET, Metabolic Evaluation |
78608 |
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