Positron Emission Tomography Scans Coverage - R22

This coverage article has been revised and published for notice under contract numbers: 02102 (AK), 02202 (ID), 02302 (OR), 02402 (WA), 03102 (AZ), 03202 (MT), 03302 (ND), 03402 (SD), 03502 (UT), and 03602 (WY).

Effective Date: January 01, 2019
Summary of Article Changes: The following updates were made to be consistent with NCD 220.6.17 (CR 10859).

List 1
C44.01, C44.212, C44.219, C44.311, C44.319, C96.21, C96.22
Deleted: C02.3, C43.10, C43.30, C43.9, C44.300, C50.911, C50.912, C50.921, C50.922, C81.00, C81.10, C81.20, C81.30, C81.40, C81.70, C81.90, C82.00, C82.10, C82.20, C82.30, C82.40, C82.50, C82.60, C82.80, C82.90, C83.00, C83.10, C83.30, C83.50, C83.70, C83.80, C83.90, C84.00, C84.10, C84.40, C84.60, C84.70, C84.A0, C84.Z0, C84.90, C85.10, C85.20, C85.80, C85.90, C96.5, C96.6, R93.9, Z85.20, Z85.819

List II
C44.510, C44.511, C44.519, C45.7, C54.0, C70.0, C70.1, Z85.43
Deleted: C26.0, C38.3, C39.0, C39.9, C44.90, C47.6, C49.6, C49.9, C55, C60.9, C62.91, C62.92, C63.9, C67.9, C68.9, C69.91, C69.92, C72.9, C7A.00, C77.9, C78.30, C78.80, C79.40, C79.9, Z85.00, Z85.40, Z85.45, Z85.50, Z85.819

List III
C94.40, C94.41, C94.42, C94.6

List IV
Deleted: D37.039, D37.9, D38.6, D39.10, D39.9, D40.10, D40.09, D41.00, D41.10, D41.20, D41.9, D42.9, D43.2, D43.9, D44.10, D44.9, D48.60, D49.0, D49.1, D49.2, D49.3, D49.4, D49.6, D49.7, D49.81, D49.89, D49.9

List V
D47.Z9, D47.9

Group 11
C7A.00, C78.30, C78.80

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            Last Updated Mon, 03 Aug 2020 14:25:05 +0000