CMSNational Coverage Determination (NCD)

Single Photon Emission Computed Tomography (SPECT) Form

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Single Photon Emission Computed Tomography (SPECT)

Notes: Frequency limitations are subject to Medicare Administrative Contractor discretion.

Indications

(321213) Is the SPECT scan indicated for a stress fracture diagnosis? 
(321214) Is the SPECT scan indicated for spondylosis diagnosis? 
(321215) Is the SPECT scan indicated for detecting an infection, such as discitis? 
(321216) Is the SPECT scan indicated for detecting a tumor, such as osteoid osteoma? 
(321217) Is the SPECT scan intended to analyze blood flow to an organ, such as assessing myocardial viability? 

YesNoN/A
YesNoN/A

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Effective Date

10/01/2002

Last Reviewed

NA

Original Document

  Reference



Background for this Policy

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.

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.

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