CMS Pub. 100-04, ch. 13, § 60.2.1

AB-02-065

The FDG PET is covered for the determination of myocardial viability following an inconclusive single

photon computed tomography test (SPECT) from July 1, 2001, through September 30, 2002. Only full

ring scanners are covered as the scanning medium for this service from July 1, 2001, through December

31, 2001. However, as of January 1, 2002, full and partial ring scanners are covered for myocardial

viability following an inconclusive SPECT.

Beginning October 1, 2002, Medicare will cover FDG PET for the determination of myocardial viability

as a primary or initial diagnostic study prior to revascularization, and will continue to cover FDG PET

when used as a follow-up to an inconclusive SPECT. However, if a patient received a FDG PET study

with inconclusive results, a follow-up SPECT is not covered. FDA full and partial ring PET scanners

are covered.

In the event that a patient receives a SPECT with inconclusive results, a PET scan may be performed and

covered by Medicare. However, a SPECT is not covered following a FDG PET with inconclusive

results. See the Medicare National Coverage Determinations Manual for specific frequency limitations

for Myocardial Viability following an inconclusive SPECT.

In the absence of national frequency limitations, contractors can, if necessary develop reasonable

frequency limitations for myocardial viability.

Documentation that these conditions are met should be maintained by the referring physician as part of

the beneficiary’s medical record.