Provider Documentation Required with the PET Scan Claim

Medicare contractors shall inform providers to ensure the conditions mentioned in the NCD Manual, section 220.6.13, have been met. The information must also be maintained in the beneficiary's medical record:

- Date of onset of symptoms;

- Diagnosis of clinical syndrome (normal aging, mild cognitive impairment or MCI: mild, moderate, or severe dementia);

- Mini mental status exam (MMSE) or similar test score;

- Presumptive cause (possible, probably, uncertain AD);

- Any neuropsychological testing performed;

- Results of any structural imaging (MRI, CT) performed;

- Relevant laboratory tests (B12, thyroid hormone); and,

- Number and name of prescribed medications.

B. Billing Requirements for Beta Amyloid Positron Emission Tomography (PET) in Dementia and Neurodegenerative Disease:
Effective for claims with dates of service on and after September 27, 2013, Medicare will only allow coverage with evidence development (CED) for Positron Emission Tomography (PET) beta amyloid (also referred to as amyloid-beta (Aß)) imaging (HCPCS A9586)or (HCPCS A9599) (one PET Aß scan per patient).


NOTE: Please note that effective January 1, 2014 the following code A9599 will be updated in the IOCE and HCPCS update. This code will be contractor priced