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What is PET-CT?
PET-CT is a powerful, noninvasive diagnostic imaging procedure that assesses the level of metabolic activity in normal and abnormal human tissue. A PET scanner consists of an array of detectors that surround the patient. Using the gamma rays given off by the injected radionuclide, PET measures the amount of metabolic activity at different sites throughout the body and a computer reassembles the data into tomographic images. Most cancer cells have much higher metabolic rates and glucose utilization than normal cells, and show up as brighter areas on a PET scan.
What does it add to anatomic imaging?
Because PET measures metabolism, as opposed to MRI or CT, which show structure, it can be superior to these modalities, particularly in separating tumors from benign lesions, and in differentiating malignant from nonmalignant residual masses or scars following treatment. In addition, whole body imaging (usually from the base of the skull to midthighs) with PET-CT provides the means to examine most organ systems for both primary and metastatic disease in a single procedure.
How accurate is PET-CT?
PET-CT is considered the most advanced imaging modality for identification of cancer; for differentiation between malignant and benign disease; for differentiation between recurrent or residual disease and therapy-induced changes; and for monitoring response to therapy.
What should the patient expect?
The patient arrives after fasting for at least four hours (except for water), and receives an intravenous injection of FDG. A CT scan and a PET emission scan are performed approximately one hour later and take about 30 minutes.
When is PET-CT covered?
Most commercial insurance companies have a broad coverage policy for PET-CT. Medicare currently covers PET-CT for many indications in oncology. PET has also been extensively studied in other cancers, which are covered by Medicare under the National Oncologic PET registry (NOPR) with submission of some clinical data.
Cancers and indications that are reimbursable by Medicare are NOT eligible for entry in the NOPR. Cancers and indications that are specifically excluded for Medicare reimbursement are also not eligible for entry in the NOPR.
C = covered - Not eligible for entry in the NOPR
NC = non-covered nationally - Not eligible for entry in the NOPR
NOPR = covered only with entry in the NOPR
|Indications||Initial Treatment Strategy
(formerly Diagnostic and initial staging)
Subsequent Treatment Strategy
|Cervix (180)||C / NC4||C|
|Colon (153) and Rectum (154)||C||C|
|Connective/other soft tissue (171)||C||NOPR|
|Female breast (174)||C / NC2,3||C|
|Gallbladder & extrahepatic bile ducts (156)||C||NOPR|
|Kaposi’s sarcoma (176)||C||NOPR|
|Kidney and other urinary tract (189)||C||NOPR|
|Lip, Oral Cavity and Pharynx (140-149)||C||C|
|Liver and intrahepatic bile ducts (155)||C||NOPR|
|Lung, non-small cell (162)||C||C|
|Lung, small cell (162)||C||NOPR|
|Male breast (175)||C / NC2,3||C|
|Melanoma (172)||C / NC2||C|
|Metastatic cancer / unknown primary origin (196-199)||C||NOPR|
|Nasal cavity, ear, and sinuses (160)||C||C|
|Neuroendocrine tumor (209)||C||NOPR|
|Non-melanoma skin (173)||C||NOPR|
|Other and unspecified female genitalia (184)||C||NOPR|
|Other and unspecified nervous system (192)||C||NOPR|
|Other endocrine glands and related structures (194)||C||NOPR|
|Other or not listed||C||NOPR|
|Penis and other male genitalia (187)||C;||NOPR|
|Primary Brain (191)||C||NOPR|
|Retroperitoneum and peritoneum (158)||C||NORP|
|Small Intestine (152)||C||NOPR|
|Thymus, heart, mediastinum (164)||C||NOPR|
|Thyroid (193)||C||C / NOPR5|
|Uterine adnexa (183.2-183.9)||C||NOPR|
|Uterus, body (182)||C||NOPR|
|Uterus, unspecified (179)||C||NOPR|
1 Some Medicare contractors include anal cancer in their local coverage of "colorectal cancer"; for PET facilities served by those carriers, PET for subsequent treatment evaluation of anal cancer would be a covered indication.
2 PET is non-covered for initial staging of axillary lymph nodes in patients with breast cancer and of regional lymph nodes inpatients with melanoma, but is covered for detection of distant metastatic disease in high-risk patients with breast cancer or melanoma.
3 PET is non-covered for "diagnosis" of breast cancer to evaluate a suspicious breast mass. However, PET is covered for initial treatment strategy evaluation of a patient with axillary nodal metastasis of unknown primary origin or in a patient with a paraneoplastic syndrome potentially caused by an occult breast cancer.
4 PET is covered for initial staging of cervical cancer. PET is not covered for "diagnosis" of cervical cancer.
5 To qualify as a covered indication for subsequent treatment strategy evaluation, thyroid cancer must be of follicular cell origin and been previously treated by thyroidectomy and radioiodine ablation and the patient must have a serum thyroglobuilin > 10ng/mL and a negative whole-body I-131 scan. Patients who do not qualify for this covered indication (e.g., because the tumor is of other than follicular cell origin (which includes papillary and follicular carcinomas), the thyroglobulin is not elevated, or I-131 whole-body imaging was not performed or is positive) can be entered on NOPR.
To schedule a PET-CT, call 410-918-3520.