Positron Emission Tomography ( 13N-ammonia) for Myocardial Perfusion

CMS determines that the evidence is adequate to conclude that the use of 13N-ammonia PET for the evaluation of myocardial perfusion is reasonable and necessary for the diagnosis or treatment of the illness or injury or to improve the functioning of a malformed body member in the population specified.

In addition, CMS determines that the evidence is adequate to impose the following limitations:

The PET scan, whether at rest alone, or rest with stress, is performed in place of, but not in addition to, a single photon emission computed tomography (SPECT); or

The PET scan, whether at rest alone or rest with stress, is used following a SPECT that was found to be inconclusive. In these cases, the PET scan must have been considered necessary in order to determine what medical or surgical intervention is required to treat the patient. (For purposes of this requirement, an inconclusive test is a test(s) whose results are equivocal, technically uninterpretable, or discordant with a patient’s other clinical data and must be documented in the beneficiary’s file.

Therefore, we intend to issue a positive national coverage determination announcing the addition of coverage for 13N-ammonia PET for the evaluation of myocardial perfusion.

Centers for Medicare & Medicaid Services. 2003 Apr
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