BlueCross BlueShield (BCBS) of Tennessee has announced it will offer Medicare coverage for cardiac PET scans, beginning later this year.
The decision comes in the wake of a September 1 letter from the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the American Society of Nuclear Cardiology (ASNC) asking BCBS to expand its coverage.
The expanded coverage policy for PET includes the following:
- PET is considered medically necessary if the medical appropriateness criteria are met.
- PET for the diagnosis or evaluation of all other nononcologic and/or noncardiac conditions/diseases is considered investigational.
- PET is considered medically appropriate if any one of the following is met: imaging of the adult or pediatric brain as part of preoperative planning for epilepsy surgery, imaging of adult abdominal lymph node lesion if previous biopsy is negative or inconclusive, and imaging of a pediatric mediastinal mass prior to biopsy if lymphoma is suspected or there is evidence of tracheal compression.
