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

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 for auxillary lymph nodes in patients with breast cancer and of regional lymph nodes in patients 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 non-covered for "diagnosis" of cervical cancer. However, PET is covered for initial staging 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 negative whole-body I-131 scan. Patients who do not qualify for this covered indication (e.g., because tumor is of other than follicular cell origin, the thryoglobulin is not elevated, or I-131 whole-body imaging was not performed or is positive) can be entered on NOPR.

1. The scientific evidence concerning the clinical utility of FDG-PET is generally less robust for cancers and indications that are currently covered by Medicare only in the NOPR than for cancers and indications that are currently covered without the requirement for clinical data submission to the NOPR. For this reason, Medicare has conditioned coverage of FDG-PET under the NOPR on the collection of clinical data. These data will be used to help determine the clinical utility of FDG-PET for conditionally covered cancers and indications. The billing physician remains responsible for documenting medical necessity, which is required for the coding and billing of both covered and NOPR-eligible PET studies. Eligibility for the NOPR does not constitute a clinical management recommendation for the use of PET for the conditionally covered cancers and indications, by either the Medicare program or NOPR investigators. Referring and interpreting physicians are thus advised to refer to the published literature to better understand the potential limitations of FDG-PET for NOPR-eligible uses.
2. The ICD-9-CM^® codes in the table above are provided for reference purposes only and for guidance in completion of the cancer type on the pre-PET form for cases included in the NOPR. Each provider should refer to the coverage policy of its respective Medicare contractor to determine which ICD-9-CM^® codes are indicative of medical necessity. Note also that, although PET is covered to aid in the diagnosis of strongly suspected cancers, claims submitted with the appropriate non-cancer ICD-9-CM^® code(s) may not be paid without medical necessity appeal.
3. PET imaging of the brain with CPT code 78608 is covered for those cancers and indications designated by "C" in the table above and is covered only under NOPR for those cancers and indications indicated by "NOPR" in the table above.