BlueCross BlueShield of Tennessee expands Medicare coverage for cardiac PET

BlueCross BlueShield of Tennessee has decided to expand Medicare coverage for cardiac PET, effective later this year. The news comes after the Society of Nuclear Medicine & Molecular Imaging (SNMMI) and the American Society of Nuclear Cardiology proposed the provider expand its coverage in a letter back on Sept. 1.

This expanded coverage, SNMMI detailed on its website, states that PET is considered medically necessary if medical appropriateness criteria are met and PET  to diagnose or evaluate non-oncologic and/or noncardiac conditions is viewed as investigational. In addition, PET is viewed as medically appropriate if any of these three statements is found to be true:

• “Imaging of the adult or pediatric brain as part of preoperative planning for epilepsy surgery.”
• “Imaging of adult abdominal lymph node lesion if previous biopsy is negative or previous biopsy is inconclusive.”
• “Imaging of a pediatric mediastinal mass prior to biopsy if lymphoma is suspected or there is evidence of tracheal compression.”