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Medicare Coverage



Indication
 Covered1
 Nationally Non-Covered2 Covered in the Data Registry3
Brain

X
Breast
Diagnosis
Initial staging of axillaries nodes
Staging of distant metastasis
Restaging, monitoring *


X
X
X
X
Cervical
Staging as adjunct to conventional  imaging
Other staging
Diagnosis, restaging, monitoring *
X


X
X
Colorectal
Diagnosis, staging, restaging
Monitoring *
X


X
Esophagus
Diagnosis, staging, restaging
Monitoring *
X


X
Head and Neck (non-CNS/thyroid)
Diagnosis, staging, restaging
Monitoring *
X


X
Lymphoma
Diagnosis, staging, restaging
Monitoring *
X


X
Melanoma
Diagnosis, staging, restaging
Monitoring *
Staging of regional lymph node
X


X

X
Non small cell lung cancer
Diagnosis, staging, restaging
Monitoring *
X


X
Ovarian

X
Pancreatic

X
Small cell lung

X
Soft tissue sarcoma

X
Solitary pulmonary nodule (characterization)
 X

Thyroid
Staging of follicular cell tumors
Restaging of medullar cell tumors
Diagnosis, staging, restaging
Monitoring *
X


X
X
X
Testicular

X
All other cancers not listed herein

X

1 Covered nationally based on evidence of benefit.  Refer to National Coverage Determination Manual for specific coverage language and limitations for each indication.
http://www.cms.hhs.gov/manuals/103_cov_determ/ncd103c1_Part4.pdf

2 Non-covered nationally based on lack of evidence sufficient to establish either benefit or harm.

3 Non-covered nationally based on lack of evidence sufficient to establish either benefit or harm or no prior decision addressing this cancer.  These indications will be covered when the scan is performed as part of the National PET Data Registry

* Monitoring = monitoring response to treatment when a change in therapy is anticipated


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