![]() ![]() ![]() PET is considered medically necessary in situations in which clinical management of the member would differ depending on the stage of the cancer identified and either: Therefore, the use of PET in the diagnosis of lymphoma, esophageal carcinoma, colorectal cancers, and melanoma is rarely considered medically necessary. PET scans following a tissue diagnosis are performed for the purpose of staging, not diagnosis. In general, for most solid tumors, a tissue diagnosis is made prior to the performance of PET scanning. The PET results may assist in avoiding an invasive diagnostic procedure, or the PET results may assist in determining the optimal anatomic location to perform an invasive diagnostic procedure. PET-CT Fusion: The fusion of PET and CT imaging into a single system (PET/CT fusion) is considered medically necessary for any indication where PET scanning is considered medically necessary. Upon individual case review, FDG-PET scanning may be considered medically necessary for other oncologic indications that are not listed as medically necessary below, when the conventional imaging that is indicated for that oncologic indication is equivocal, and general medical necessity criteria for oncologic indications (section B.1.
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