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FDG PET for Infection and Inflammation

CMS reconsidered the current, de facto non-coverage for FDG PET imaging for off-label indications chronic osteomyelitis, infection of hip arthroplasty, and fever of unknown origin, each in lieu of bone, leukocyte, and/or gallium scintigraphy. CMS determines it will continue its national non-coverage policy for FDG PET for the requested indications. Additionally, CMS determines
that this request is not appropriate for the coverage with evidence development paradigm. This addition of section 220.6.16 is an NCD. NCDs are binding on all carriers, fiscal intermediaries, quality improvement organizations, qualified independent contractors, the Medicare appeals council, and administrative law judges (ALJs) (see 42 CFR section 405.1060(a)(4) (2005)). An NCD that expands coverage is also binding on a Medicare advantage organization. In addition, an ALJ may not review an NCD. (See section 1869(f)(1)(A)(i).)

Download the Guidance Document

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: June 27, 2008

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.