Does A9552 require prior authorization?

No, A9552 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for A9552?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`A9552`, Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Medical records must be maintained and available upon request, be legible, include complete patient identification and dates of service, and contain the legible signature of the physician or non‑physician practitioner responsible for care.
The submitted medical record must support the selected ICD‑10‑CM diagnosis code(s) and the CPT/HCPCS code billed must accurately describe the service performed.

When PET and diagnostic CT scans are performed: (a) PET and separately obtained diagnostic CT on the same date but in a separate session may be coded individually; (b) a hybrid PET/CT plus an additional diagnostic CT obtained non‑concurrently may be coded separately; and (c) the CT component of a PET/CT used only for attenuation correction/localization is not a diagnostic CT and should not be billed as such.

Key Coverage Criteria

FDG PET (CPT 78608 / HCPCS A9552) is covered to differentiate Alzheimer's disease (AD) from frontotemporal dementia (FTD) in patients with a recent dementia diagnosis who have documented cognitive decline for at least 6 months and who meet diagnostic criteria for both AD and FTD.
FDG PET is covered for patients with mild cognitive impairment (MCI) or early dementia only when performed as part of a CMS‑approved practical clinical trial (coverage with evidence development).
FDG PET (CPT 78608) is covered for intractable seizures only when used as part of a pre‑surgical evaluation for seizure focus localization.
FDG PET (CPT 78608 / tracer A9552) is covered to differentiate Alzheimer's disease (AD) from Fronto-temporal dementia (FTD) in patients recently diagnosed with dementia who have documented cognitive decline of at least 6 months and who meet diagnostic criteria for both AD and FTD.
FDG PET (CPT 78608) is covered for intractable seizures only when used as part of a pre-surgical evaluation.
FDG PET is covered for patients with mild cognitive impairment (MCI) or early dementia only when performed within a CMS-approved practical clinical trial following an approved protocol (report claims with Q0 modifier).

13 Active Policies

CGS-J15-L39521, Positron Emission Tomography (PET) Scan for Inflammation and Infection

J15

CGS-J18-L39521, Positron Emission Tomography (PET) Scan for Inflammation and Infection

J18

A59049, Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions

A53134, Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions

BCBSNM-RAD605.001, Cardiac Applications of Positron Emission Tomography Scanning

BCBSOK-RAD605.001, Cardiac Applications of Positron Emission Tomography Scanning

CARELON-imaging-of-the-brain-2024-10-20, Imaging of the Brain

CARELON-imaging-of-the-brain-2025-11-15-updated-2026-01-01, Imaging of the Brain

CARELON-oncologic-imaging-2025-11-15, Oncologic Imaging

CARELON-oncologic-imaging-2026-04-04, Oncologic Imaging

A59318, Billing and Coding: Positron Emission Tomography (PET) Scan for Inflammation and Infection

BCBSIL-RAD605.001, Cardiac Applications of Positron Emission Tomography Scanning

BCBSMT-RAD605.001, Cardiac Applications of Positron Emission Tomography Scanning

`A9552`, Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

13 Active Policies

Related Codes

Have a follow-up question?

A9552, Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

13 Active Policies

Related Codes

Have a follow-up question?

`A9552`, Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries