PET Scan (Positron Emission Tomography) Form

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PET Scan (Positron Emission Tomography) Medical Guideline

Service: PET Scan (Positron Emission Tomography)

PUM 250-0010-1712

Medical Guideline Committee Approval Q1 2026 Effective Date 05/01/2026

Description:

A positron emission tomography (PET) scan is used to evaluate differences in structure or organ function and metabolism. The PET scan shows molecular function and activity, which is not available with other imaging methods. The PET scanner detects signals from a radioactive substance/tracer, such as (the most commonly used tracer) Fluorine-18 fluorodeoxyglucose (FDG), 18F Sodium Fluoride (18F-NaF), Choline C-11, somatostatin receptor imaging Gallium Ga-68, or 18F for prostate cancer imaging with additional FDA approved PET radiopharmaceuticals including Cu-64, Nitogen-13 and Rubidium-82. Because most cancers are hypermetabolic, compared with standard tissue, cancerous tissue will typically absorb more radioactive substances and appear brighter than normal tissue on the PET images. PET is most commonly utilized in oncologic (cancer/tumor), cardiac, and neurologic conditions.

The PET images are commonly fused to an additional imaging modality, usually computed tomography (CT) or magnetic resonance imaging (MRI), to improve spatial resolution. For the purposes of this guideline, future use of the term PET/CT may be used interchangeably with PET/MRI.

For the purposes of this guideline, diagnosis, staging, restaging, monitoring, and surveillance are defined as follows:

Diagnosis:
There are two general diagnostic uses of PET:

1) A PET may be performed before a pathology confirmed diagnosis has been made when

there is a strong suspicion of cancer based on other diagnostic testing.

2) A PET may be ordered when the results are needed to determine the need for an invasive

procedure, such as a biopsy, or determine the best anatomic location for an invasive

procedure.

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Staging (also known as Initial Treatment Strategy and Initial Anti-tumor Treatment Strategy): The PET is performed after a pathology report has confirmed the presence of a malignancy; but prior to any treatment being performed. PET is indicated when the clinical management of the patient would be altered depending on the stage of the cancer and: either staging of cancer is inconclusive after completed standard diagnostic evaluation [computed tomography (CT), magnetic resonance imaging (MRI) and/or ultrasound (US)] or when PET would replace one or more conventional imaging studies (when those studies are inadequate for treatment management). Restaging or monitoring (also known as Subsequent Treatment Strategy):

PET scans needed either:

a) during active treatment (chemotherapy, immunotherapy, radiation, and prolonged therapy to help control known metastases), OR

b) a solitary PET scan at end of treatment, within 6 months of completing active treatment, OR

c) for clinical concern for recurrence (such as rising tumor markers, labs, suspicious results of other imaging, or clinically suspicious symptoms).

Surveillance / Remission: The PET is performed to assess for possible changes in status when there are no signs or symptoms of active cancer changes and the patient is not on any active treatment, and the PET is to be performed greater than 6 months after completion of treatment. The PET scan for detecting recurrence without documentation of signs of recurrence (such as new or changing signs and symptoms, abnormal laboratory tests, or abnormal imaging studies) is generally not medically necessary.

Indications of Coverage:

PET or PET/CT scan is considered medically necessary for ANY of the following conditions when the indicated condition-specific criteria are met:

I. Oncologic PET Scan:

For the following Solid tumor malignancy or hematologic malignancy, biopsy

proven or strongly suspected, criteria for initial and restaging PET imaging are

provided:

A. Adrenal—Initial--if conventional imaging and/or biochemical evaluation suggests adrenal cortical carcinoma. Restaging—additional imaging indeterminate.

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B. AIDS related Kaposi Sarcoma—Initial—suspected Kaposi’s related cytokine syndrome or lymphoma. Restaging---not considered medically necessary, not indicated.

C. Urinary Bladder Cancer –Initial—with muscle invasive disease only when there is indeterminate imaging outside the urinary tract. Restaging—with suspected metastatic disease or recurrence outside the urinary
tract and alternate imaging is indeterminate.

D. Anal carcinoma--Initial and Restaging—with indeterminate results from prior imaging.

E. Brain cancer/tumor—Initial---to evaluate meningioma, primary brain lymphoma, to differentiate low from high grade glioma, or to guide biopsy/intervention. Restaging—to differentiate radiation or post treatment change from recurrent/residual tumor, or to help evaluate progress after treatment or surgery.

F. Cholangiocarcinoma/ gall bladder carcinoma (Biliary Tract) --Initial and Restaging--- with indeterminate results from prior imaging.

G. Chordoma--Initial and Restaging—with indeterminate results from prior imaging.

H. Ewing’s sarcoma and osteosarcoma--Initial---for all indications** Restaging—for all indications when PET was used for initial staging, or with
known or suspected metastatic disease.

I. Breast cancer--Initial and Restaging -- with indeterminate results from prior imaging.
Restaging with fluoroestadiol—F18, with biopsy proven recurrent/metastatic ER

• disease when results will affect treatment plan.

  J. Castleman’s disease-- Initial and Restaging-- with indeterminate results from prior imaging.

  K. Histiocytic neoplasms (such as Langerhan’s or Erdheim-Chester)--Initial—for all indications.

         Restaging—if on active treatment.

  L. Cervical cancer—Initial—If Stage 1B1 or higher.
  Restaging—for all indications. **

  M. Leukemias----

  a) for ALL (Acute Lymphoblastic Leukemia) and AML (Acute

  Myelogenous Leukemia) --Initial and Restaging---only if suspected or

  known extramedullary involvement/disease.

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b) for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic

Leukemia (SLL)--Initial—for suspected high-grade transformation or

to direct nodal tissue sampling/biopsy.

Restaging—with accelerated CLL or with indeterminate imaging

and testing needed to direct biopsy.

c) For all other leukemias--Initial and Restaging—with involvement of

lymph nodes, soft tissue, or extramedullary tissues.

N. Colorectal cancer---Initial--with prior inconclusive imaging OR metastatic disease when results of the scan will directly impact treatment. Restaging-- with prior inconclusive imaging (such as rising CEA and no anatomic source seen), OR metastatic disease when results of the scan will directly impact treatment.

O. Endometrial cancer –Initial and Restaging--with prior inconclusive imaging.

P. Esophageal or gastroesophageal junction cancer---Initial—with no other evidence of metastatic disease.
Restaging—following chemoradiation OR with prior inconclusive imaging.

Q. Fallopian tube cancer---Initial and Restaging--- with indeterminate results from prior imaging.

R. Gastrointestinal Stromal Tumors (GIST)--Initial and Restaging---with indeterminate results from prior imaging.

S. Gastric (stomach) cancer --Initial---with no evidence of metastatic disease on prior imaging.
Restaging-- with prior inconclusive imaging.

T. Gestational Trophoblastic Neoplasm--Initial--with inconclusive prior imaging.
Restaging---with inconclusive prior imaging OR after completing chemotherapy, when HCG not deemed reliable.

U. Hepatocellular (liver)—Initial and Restaging-- with inconclusive prior imaging.

V. Head and neck cancer---Initial and Restaging—for all indications. **

W. Lung Cancer—Non-Small Cell Lung Cancer—Initial and Restaging—for all indications. **

X. Lung Cancer—Small Cell–Initial—for all indications with early stage, for more advanced tumor, only if other imaging does not document extensive disease.

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Restaging—for early stage, with indeterminate imaging or to determine radiation fields. For later stage, not indicated unless required to determine radiation fields.

Y. Lymphoma (Hodgkin’s or Non-Hodgkin’s B-cell or T-cell) --Initial and Restaging---for all indications. **

Z. Melanoma-Cutaneous--Initial and Restaging---only for Stage III or IV.

AA. Melanoma-Uveal—Initial—No indications.
Restaging--with prior inconclusive imaging.

BB. Merkel Cell malignancy—Initial and Restaging--- for all indications. **

CC. Multiple Myeloma--Initial—for all indications.
Restaging—for smoldering myeloma, indicated annually or more frequently if dictated by symptoms/labs. For any other myeloma, for all indications. **

DD. Mesothelioma--Initial and Restaging--only prior to surgery for stage IIIA or less.

EE. Neuroblastoma--Initial—with MIBG (iodine meta-iodobenzylguanidine) testing is negative or inconclusive or discordant to pathology.
Restaging—with inconclusive/discordant MIBG testing.

FF. Neuroendocrine tumors or carcinoid tumors of the GI tract, pancreas, lung or thymus, or of unknown origin, (also to include pheochromocytoma and paraganglioma) --Initial—for all indications (may use somatostatin receptor agent--SSTR).
Restaging—for suspected progression based on labs and/or other imaging, or when somatostatin receptor directed therapy is being considered.

GG. Ovarian/Primary Peritoneal Cancer—Initial and Restaging—with indeterminate prior imaging,
Restaging--also with discordant results from CA-125 and imaging

HH. Pancreatic cancer--Initial—with prior indeterminate imaging or question of resectable disease
Restaging—only if PET was used for initial staging and need to assess treatment response, whether surgery is now an option.

II. Penile cancer--Initial and Restaging--with inconclusive prior imaging.

JJ. Post Transplant Lymphoproliferative disorder--Initial and Restaging---For all indications. **

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KK. Prostate cancer –FDG PET not indicated Initial—PSMA PET with non- metastatic disease of risk at least unfavorable intermediate or worse (Gleason 7, 8, 9, or 10).
Restaging—PSMA PET on post radical prostatectomy members with persisting PSA >0.1 or rising PSA, OR with known metastases and disease progression as demonstrated by rising PSA or worsening imaging results, OR after 12 weeks treatment with Lu-177.

LL. Skin cancer/squamous cell carcinoma---Initial and Restaging—indicated with at least one biopsy proven nodal or extracutaneous metastasis.

MM. Small Bowel Carcinoma—Initial—not indicated.
Restaging-- with inconclusive prior imaging.

NN. Soft tissue sarcoma – Rhabdomyosarcoma--Initial and restaging for all indications. Gastrointestinal stromal tumors and other soft tissue sarcomas-- Initial--if under age 30, for all indications, if over age 30, with inconclusive prior imaging.
Restaging---for all indications. **

OO. Testicular---No indications for non-Seminoma. For seminoma, Initial— Not indicated.
Restaging-- with inconclusive prior imaging, OR residual mass at least 3cm with normal AFP and bHCG levels.

PP. Thymus cancer or thymoma---Initial and Restaging---For all indications. **

QQ. Thyroid cancer--Initial—only indicated for anaplastic cell type
Restaging---for all indications with anaplastic, with prior indeterminate/discordant imaging for papillary, medullary, follicular, oncocytic. **

RR. (Cancer of) Unknown primary origin/Occult Primary---Initial and Restaging-

• with inconclusive prior imaging.

  SS. Uterine Cancer (includes leiomyosarcoma or endometriod) --Initial and Restaging --with inconclusive prior imaging.

  TT. Vulvar Cancer--Initial--with Stage at least T2, OR with inconclusive prior imaging Restaging—for all indications. **

  For any unlisted malignancies, please refer to published guidelines of

  the National Comprehensive Cancer Network (NCCN) regarding

  recommendations for imaging/PET scanning.

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 Note: PET for surveillance or remission is generally considered not medically necessary. Neither somatostatin receptor imaging (Gallium-68 DOTATATE PET) nor FDG PET/CT are recommended for routine surveillance.

 Note: If the agent to be used for PET scan is not FDA approved, the test itself will be considered experimental, investigational, unproven. FDA approved radiopharmaceuticals for PET scan include Carbon-11 choline, Cu-64, Flourine 18, gallium 68, Nitrogen 13, Rubidium

82. Agents specifically for prostate cancer evaluation are Ga68 PSMA, Pifufolastat F18 and Flotufolastat F18.

     If an end of treatment PET scan is indeterminate, one additional PET scan, no sooner than 3 months from the prior PET, is considered medically necessary.

     Follow up PET scans at 30 days, 100 days, and 180 days after most recent infusion is medically necessary in members with allogenic bone marrow transplantation and CART T cell therapy.

    ** If guidelines for the frequency of restaging PET scans for oncologic conditions

    have been established by the National Comprehensive Cancer Center (NCCN),

    those guidelines should be applied to determine medical necessity of follow-up

    imaging.

    II. Non-oncologic (not related to cancer/malignancy) PET Scan

    A. Coronary Disease. Refer to MCG, A-0097 Myocardial Positron Emission Tomography.

    B. PET is considered medically necessary for evaluation of one of the following:

    i. Cognitive impairment or dementia
    ii. detection of Alzheimer’s disease
    iii. differentiation between Alzheimer’s or Lewy Body Dementia or frontotemporal dementia iv. to document presence of beta amyloid plaque in Alzheimer’s disease when treatments targeting beta amyloid plaque (such as aducanumab, Aduhelm) are being considered, when ALL of the following (a. through d.) are met:

    a. Documentation of cognitive decline over time.
    b. Documentation of objective assessment of mental status by neurodiagnostic testing such as: Montreal Cognitive Assessment (MoCA) or mini-mental status exam (MMSE) with score of less than 26 OR Neuropsychological testing showing at least mild cognitive impairment. c. A baseline evaluation has been completed to exclude other treatable causes of neurologic symptoms. The evaluation includes completion of basic metabolic work up (such as Complete Blood Count, Liver Function Tests, Thyroid tests) and adjustment of any medications as appropriate as well as exclusion of vascular or traumatic causes of cognitive impairment.

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d. The PET scan must be ordered by a specialist in the field of dementia or neurology.

C. PET is medically necessary for evaluation of Epilepsy when the PET scan is ordered for pre-surgical evaluation to localize/identify a focus of refractory seizure activity for individuals with intractable epilepsy (defined as poor or no response to 2 or more anticonvulsant medications at maximal dose), and the brain MRI, with respect to seizure focus, was negative or indeterminate or discordant with other testing.

D. Solitary Pulmonary Nodule (SPN) must measure ≥ 8 mm in total size and EITHER:

a. The PET/CT scan is requested for a suspicious pulmonary nodule, lacking a benign pattern of calcification, found on a recent CT. When there are multiple pulmonary nodules, at least one nodule must be solid and equal to or greater than 8 mm, OR

b. If the suspicious nodule is of mixed character, part solid and the solid component must be at least 6 mm, OR

c. A mixed nodule, ground glass and solid, with the solid component at least 4mm provided it is either new from an earlier CT scan, OR that the solid component has increased in size by at least 1.5 mm compared to earlier CT scan.

NOTE: Repeat PET scan for SPN: The PET/CT scan is requested to assess stability or change at least 90 or more days after a previous negative or inconclusive PET scan.

E. PET scan for Sarcoidosis is medically necessary ONLY if standard imaging is indeterminate regarding whether treatment is indicated OR is indeterminate as to whether the disease has responded to treatment, OR if PET is needed to determine the optimal site for biopsy.

F. PET scan for neurofibromatosis with imaging or clinical findings suspicious for transformation to malignant peripheral nerve sheath tumor (MPNST), OR for restaging of known MPNST and prior imaging is indeterminate.

Limitations of Coverage:

Benefit Limitations: Please note that in listing services or examples, when we say “this includes,” it is not our intent to limit the description to that specific list. When we do intend to limit a list of services or examples, we state specifically that the list “is limited to.” A. Review contract and endorsements for exclusions and prior authorization or benefit requirements.

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B. If requested/used for a condition/diagnosis other than is listed in the Indications of Coverage, it will be considered experimental or investigative.

C. If requested/used for a condition/diagnosis that is listed in the Indications of Coverage; but the criteria are not met, it will be considered not medically necessary.

D. If used in conjunction with a clinical trial, the PET scan is subject to medical necessity review and all other conditions and terms of the guideline or health plan certificate.

E. A PET scan for routine surveillance in an asymptomatic individual without documentation of signs of recurrence (such as new or changing signs and symptoms, abnormal laboratory tests, or abnormal imaging studies) is considered not medically necessary.

F. A PET scan to monitor an oncology patient for more than 6 months after having completed active treatment, and without documentation of signs of recurrence (such as new or changing signs and symptoms, abnormal laboratory tests, or abnormal imaging studies) is considered not medically necessary.

G. Surveillance PET scanning of neuroendocrine tumors is considered not medically necessary.

H. Repeat PET/CT to assess stability or change of a solitary pulmonary nodule within less than 90 days of a negative or inconclusive PET scan is considered not medically necessary.

I. A PET scan for any of the following conditions is considered experimental, investigational, and unproven to affect health outcomes as there is insufficient peer- reviewed scientific literature supporting the usefulness and effectiveness of PET scan in individuals with these diagnoses:

1. BCC- Basal cell carcinoma of the skin

2. Bladder cancer-non muscle invasive (by imaging or tissue sample)

3. Chondrosarcoma (bone) not indicated for initial or restaging

4. Infection and/or inflammation or failure to thrive/weight loss

5. Lung cancer (small cell) initial or restaging for extensive disease

6. For evaluation of any Stage 1 or Stage 2 melanoma

7. Paget’s Disease

8. Use of any FDG tracer for evaluation of prostate cancer

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9. Renal cancer-initial and restaging

10. For any non-seminomatous testicular cancer

    J. PET Scan using 18F-NaF tracer without current, inconclusive bone scan is considered not medically necessary.

    K. If a PET scan with either 18F-FDG, PMSA agents or SSTR agents, 18F-NaF, Ga-68, or Choline C-11 is indicated, performing more than one PET scan (using a different tracer for each scan) is considered not medically necessary.

    Documentation Required:

    Prior authorization is required for all PET scan procedures. To obtain prior authorization, the requesting provider must submit the following information:

    • A standard written order (SWO), prescribed by a qualified healthcare provider concerning the patient’s diagnosis. • Medical record information (including continued need/use if applicable) and medical necessity. • Correct coding for the service that meets all coding guidelines.

    Disclaimer: This guideline is for informational purposes only and does not constitute medical advice, plan authorization, an explanation of benefits, or a guarantee of payment. Benefit plans vary in coverage and some plans may or may not provide coverage for all services listed in this guideline. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and federal law. Some benefit plans administered by the organization may not utilize Medical Affairs medical guideline in all their coverage determinations. Contact customer services as listed on the member card for specific plan, benefit, and network status information.
    Medical guidelines are based on constantly changing medical science and are reviewed annually and subject to change. The organization uses tools developed by third parties, such as the evidence-based clinical guidelines developed by MCG to assist in administering health benefits. This medical guideline and MCG guidelines are intended to be used in conjunction with the independent professional medical judgment of a qualified health care provider. To obtain additional information about MCG, email medical.policies@wpsic.com. Coverage of all services is subject to medical necessity and services deemed experimental, investigational, and/or unproven are therefore not considered medically necessary under the terms of the clinical guidelines and will not be covered. State mandates, laws or benchmark supersede this medical guideline.

    Imaging is considered medically necessary only when indicated per the most current medical references and specialty society guidelines, such as MCG, NCCN, etc.

    **All imaging related to cancer care, WPS uses NCCN as a primary reference.

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Medical Guideline Review History

Implemented 12/06/12, 04/04/14, 07/01/15, 07/01/16, 05/22/17, 04/01/18, 01/01/19, 04/01/19, 04/01/2020, 01/01/21, Reimplemented 01/01/24, 10/01/24, 09/01/25, 05/01/26 Medical Guideline Committee Approval 03/07/14, 03/13/15, 03/11/16, 03/17/17, 12/01/17, 09/21/18, 12/14/18, 11/22/19, 12/11/20, 10/26/23, 09/26/24, 03/27/25, Q1 2026 Revised
11/16/12, 03/07/14, 03/13/15, 03/11/16, 03/17/17, 12/01/17, 09/21/18, 12/14/18, 11/22/19, 12/11/20, 10/26/23 Reviewed

02/25/00, 05/26/00, 06/28/02, 02/21/03, 09/08/04, 06/02/06, 05/18/07, 11/21/08, 12/28/09, 07/27/10, 11/16/12, 03/11/16, 03/17/17, 12/01/17, 09/21/18, 12/14/18, 11/22/19, 12/11/20, 10/26/23, 09/26/24, 03/27/25, Q1 2026 Developed 02/25/00 Retired 12/31/21

Approved by the Medical Director

Codes: The following codes for treatments and procedures applicable to this document are included below for informational purposes.

Code Code Description

78429 Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study; with concurrently acquired computed tomography transmission scan 78430 Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan
78431 Myocardial imaging, positron emission tomography (PET), Perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise for pharmacologic), with concurrently acquired computed tomography transmission scan
78432 Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (e.g., myocardial viability)

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78433 Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (e.g., myocardial viability); with concurrently acquired computed tomography transmission scan
78434 Absolute quantitation of myocardial blood flow (AQMBF), positron emission tomography (PET), rest and pharmacologic stress (list separately in addition to code for primary procedure)
78459 Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study
78491 Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic)
78492 Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic)
78608 Brain imaging, positron emission tomography (PET); metabolic evaluation
78609 Brain imaging, positron emission tomography (PET); perfusion evaluation
78811 Positron emission tomography (PET) imaging; limited area (e.g., chest, head/neck)
78812 Positron emission tomography (PET) imaging; skull base to mid-thigh
78813 Positron emission tomography (PET) imaging; whole body
78814 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; limited area (e.g., chest, head/neck)
78815 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh
78816 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body
G0219 PET imaging whole body; melanoma for noncovered indications
G0235 PET imaging, any site, not otherwise specified

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G0252 PET imaging, full and partial-ring PET scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes)
S8085 Fluorine-18 fluorodeoxyglucose (F-18 FDG) imaging using dual-head coincidence detection system (nondedicated PET scan)

Associated Procedure Codes Code Description 78999 Unlisted miscellaneous procedures, diagnostic nuclear medicine
A9515 Choline C-11, diagnostic, per study dose up to 20 millicuries
A9526 Nitrogen N-13 ammonia, diagnostic, per study dose, up to 40 MCI A9552 Fluorodeoxyglucose F-18 FDG, diagnostic, per study dose, up to 45 millicuries
A9555 Rubidium Rb-92, diagnostic, per study dose, up to 60 MCI
A9580 Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries
A9586 Florbetapir F18, diagnostic, per study dose, up to 10 millicuries
A9587 Gallium GA-68, Dotatate, diagnostic, 0.1 millicurie
A9588 Fluciclovine F-18, diagnostic, 1 millicurie
A9591 Fluoroestradiol F-18, diagnostic, 1 MCI
A9592 Copper CU-64, Dotatate, diagnostic, 1 MCI
A9593 Gallium GA-Hyphen68 PSMA-Hyphen11, diagnostic, (UCSF), 1 millicurie
A9594 Gallium GA-Hyphen68 PSMA-Hyphen11, diagnostic (UCLA), 1 millicurie
A9595 Piflufolastat F-18, diagnostic, 1 MCI
A9596 Gallium GA-68 Gozetotide, diagnostic, (Illuccix), 1 MCI
A9597 Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise specified
A9598 Positron emission tomography radiopharmaceutical, diagnostic, for nontumor identification, not otherwise classified
A9601 Flortaucipir F 18 injection, diagnostic, 1 MCI
A9602 Fluorodopa F-18, diagnostic, per MCI
A9608 Fluotufolastat F 18, diagnostic, 1 millicurie
A9609 Fludeoxyglucose F18 up to 15 millicuries
A9611 Flurpiridaz F18, diagnostic, 1 millicurie
A9800 Gallium GA-Hyphe68 Gozetotide, diagnostic (Locametz), 1 millicurie
C9060 Fluoroestradiol F18 diagnostic use with PET scan
C9067 Gallium GA-68, Dotatoc, diagnostic, 0.01 MCI
J3490 Unclassified drugs
Q9982 Flutemetamol F18, diagnostic, per study dose, up to 5 millicuries

Q9983 Florbetaben F18, diagnostic, per study dose, up to 8.1 millicuries