About this policy
CMS National Coverage Determination | ncd_id=271 | manual_section=220.12 | coverage_level_code=1 | national_coverage_type=True | under_review=True | lab_ncd=False
Coverage indications
Frequency limitations: Medicare Administrative Contractor discretion. In the case of myocardial viability, FDG positron emission tomography (PET) may be used following a SPECT that was found to be inconclusive. However, SPECT may not be used following an inconclusive FDG PET performed to evaluate myocardial viability.
Documentation requirements
Item/Service Description: The single photon emission computed tomograph (SPECT) acquires information on the concentration of radionuclides introduced into the patient's body. It is useful in the diagnosis of several clinical conditions including: stress fracture. spondylosis. infection (e.g., discitis). tumor (e.g., osteoid osteoma). analyze blood flow to an organ, as in the case of myocardial viability. differentiate ischemic heart disease from dilated cardiomyopathy. Cross Reference: See NCD on Positron Emission Tomography (PET) Scans . Revision History: 05/2002 - Added NCD as part of determination regarding myocardial viability. Effective and implementation dates 07/01/2002. ( TN 156 ) (CR 2138) Benefit Categories: 20 - Diagnostic Tests (other) Transmittal: transmittal_number=156 | transmittal_issue_date=2002-05-02 | change_request_number=2138
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
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