FDG PET
FDG PET Brain
(Medicare Eligibility)
Criteria for Appropriate Patient Selection
Practical Takeaway for Referring MDs
- FDG PET Brain is a narrowly defined Medicare benefit.
- Covered only when used to distinguish Alzheimer's disease (AD) from frontotemporal dementia (FTD) in patients with established dementia.
- Complete supporting documentation is required at the time of ordering.
- Coverage is governed by NCD 220.6.13 and CMS Billing & Coding A54666.
- Imaging solely to rule out FTD does not meet Medicare coverage criteria.
If the above Medicare criteria are not met, NCPIC cannot perform the study under Medicare coverage rules.
Medicare Coverage Ordering Rules (FDG PET Brain)
Medicare coverage requires an order for the differential diagnosis of Alzheimer's disease (AD) versus frontotemporal dementia (FTD)
Medicare Ordering Checklist
- Clinical diagnosis established (MCI or dementia)
- Cognitive testing score (MMSE or equivalent)
- Symptom onset documented
- Presumptive diagnosis (possible or probable AD vs FTD)
- Neuropsychological testing, if performed
- Prior structural imaging (MRI or CT)
- Relevant laboratory studies (e.g., B12, thyroid)
- Current medications (name and number)
Locations
Sacramento
Rocklin