FDG PET for Myocardial Viability

CMS National Coverage Determination | ncd_id=298 | manual_section=220.6.8 | coverage_level_code=2 | national_coverage_type=True | under_review=True | lab_ncd=False

FDG PET is covered for the determination of myocardial viability following an inconclusive single photon emission computed tomography (SPECT) test from July 1, 2001, through September 30, 2002. Only full ring PET scanners are covered from July 1, 2001, through December 31, 2001. However, as of January 1, 2002, full and partial ring scanners are covered. Beginning October 1, 2002, Medicare covers FDG PET for the determination of myocardial viability as a primary or initial diagnostic study prior to revascularization, or following an inconclusive SPECT. Studies performed by full and partial ring scanners are covered. Limitations: In the event a patient receives a SPECT test with inconclusive results, a PET scan may be covered. However, if a patient receives a FDG PET study with inconclusive results, a follow up SPECT test is not covered. Documentation that these conditions are met should be maintained by the referring physician in the beneficiary's medical record, as is normal business practice. (This NCD last reviewed September 2002.)

Item/Service Description: The identification of patients with partial loss of heart muscle movement or hibernating myocardium is important in selecting candidates with compromised ventricular function to determine appropriateness for revascularization. Diagnostic tests such as FDG PET distinguish between dysfunctional but viable myocardial tissue and scar tissue in order to affect management decisions in patients with ischemic cardiomyopathy and left ventricular dysfunction. Cross Reference: See NCDs for PET Scans (§220.6) and SPECT (§220.12). Revision History: 02/2020 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. Previous NCD coding changes appear in ICD-10 quarterly updates that can be found at: https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html , along with other CRs implementing new policy NCDs. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates. Any policy-related changes to NCDs continue to be implemented via the current, longstanding NCD process. ( TN 2439 ) (CR11655) 04/2005 - Removed text from PET Scans NCD (§220.6) and created a separate NCD. Effective date 01/28/05. Implementation date 04/18/05. ( TN 31 ) (CR 3741) Benefit Categories: 20 - Diagnostic Tests (other) Transmittal: transmittal_number=31 | transmittal_issue_date=2005-04-01 | change_request_number=3741