Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer Form
Procedure is not covered
Background for this Policy
A. General
Positron Emission Tomography (PET) is a minimally-invasive, diagnostic imaging procedure that assesses the level of metabolic activity and perfusion in various organ systems of the body. A positron camera (tomograph) is used to produce cross-sectional tomographic images, which are obtained from positron-emitting radioactive tracer substances (radiopharmaceuticals) such as F-18 sodium fluoride (NaF-18).
B. Nationally Covered Indications
The confirmatory analyses were not published during the 24-month time period. Therefore, effective December 15, 2017, CMS determines that there are no nationally covered indications for PET NaF-18.
C. Nationally Non-Covered Indications
Effective December 15, 2017, CMS determines that PET NaF-18 PET is nationally non-covered.
D. Other
Other PET radiopharmaceutical tracers for cancer can be covered at local Medicare Administrative Contractor discretion when used according to their FDA-approved indication(s).
(This NCD last reviewed December 2017.)
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