Positron Emission Tomography Scans Coverage - R14

The following Noridian coverage requirements for the Positron Emission Tomography Scans National Coverage Determination (NCD) have been published under contract numbers 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV) and 01911 (Former MO-CA, HI & Territories) in the CMS Medicare Coverage Database (MCD) and on our (Noridian) website

NCD: Positron Emission Tomography (PET) Scans (220.6)

Summary of Changes:

  • Codes end-dated effective September 30, 2018: C43.11, C43.12, C44.102, C44.109, C44.122, C44.129, C44.192, C44.199, C4A.11 and C4A.12
  • Codes added effective October 1, 2018: C43.111, C43.112, C43.121, C43.122, C44.1021, C44.1022, C44.1091, C44.1092, C44.1121, C44.1122, C44.1191, C44.1192, C44.1221, C44.1222, C44.1291, C44.1292, C44.1921, C44.1922, C44.1991, C44.1992 (List I) C4A.111, C4A.112, C4A.121 and C4A.122 (List II)
  • Codes deleted effective January 1, 2019: C00.9, C02.9, C04.9, C05.9, C06.80, C06.9, C08.9, C10.9, C11.9, C13.9, C14.0, C15.9, C16.9, C17.9, C21.0, C24.9, C25.9, C26.9, C31.9, C32.9, C34.91, C34.92, C4A.30, C4A.9, C44.310, C44.320, C44.390, C44.99, C45.9, C46.9, C47.9, C48.2, C51.9, C53.9, C54.9, C71.9, C72.50, C75.9, C7A.094, C7A.095, C7A.096, C79.10 and R92.8
  • Codes added effective January 1, 2019: R77.9 (List III), C7B.01, C7B.02, C7B.03, C7B.04, C7B.09, C7B.1, C7B.8 (List II), C96.29 (List I), Z85.020, Z85.030, Z85.040, Z85.060 (List II), Z85.110 (List I), Z85.230, Z85.41, Z85.520, Z85.821 (List II)
    • NOTE: Whenever a personal history dx code (Z85.XXX) is on a claim, claim must also contain a dx from list of covered C, D, or R dx codes
  • ICD-10 codes added effective October 1, 2016, corrected from October 1, 2017: R93.41, R93.421, R93.422, and R93.49
  • ICD-10 codes moved from List I to List II: Z85.038-Z85.060

Read the complete National Coverage Determination requirements article.

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To view a complete list of all Noridian NCD coverage articles, go to National Coverage Determination (NCD) webpage and select title of interest.

To view a complete list of all CMS NCDs available, go to National Coverage Determinations (NCDs) Alphabetical Index.

            Last Updated Thu, 04 Oct 2018 11:14:58 +0000