| Mountain State Medical Policy Bulletin |
| Section: | Radiation Therapy & Nuclear Medicine |
| Number: | R-16 |
| Topic: | PET/CT Fusion Imaging for Tumor Localization |
| Effective Date: | August 1, 2005 |
| Issued Date: | August 1, 2005 |
| Date Last Reviewed: | 06/2005 |
Indications and Limitations of Coverage
All eligibility criteria and coverage guidelines that apply to PET studies will also apply to PET/CT fusion imaging based on the anatomic area imaged. This policy focuses on the PET/CT fusion imaging for tumor localization in diagnosing and treating various malignancies. For information on PET imaging as the sole imaging modality for oncologic applications, refer to Medical Policy Bulletin R-9. All eligible diagnosis codes for covered PET studies will also apply to PET/CT fusion imaging. PET/CT fusion imaging reported with a diagnosis code other than those listed as eligible will be denied as not medically necessary. A participating, preferred, or network provider cannot bill the member for the denied service. Description Multi-modality image co-registration (also known as fusion or co-registered imaging) is useful in certain clinical situations because data acquired from CT or MRI studies and PET studies yields complementary information. In PET/CT fusion imaging, the anatomic information from the SPECT/CT images is combined or "fused" with the physiologic information obtained from the PET images to localize tumors or lesions especially in regions of complex anatomy, such as in the head, neck, chest, abdomen and pelvis. There are two methods of PET/CT co-registered or fusion imaging. One method involves the use of special computer software that combines or "fuses" the anatomic information from previously acquired the SPECT/CT images with the physiologic or functional information obtained from the PET study. This software fusion method is more labor intensive and at times unsuccessful, because the patient is imaged by two different modalities during two different imaging sessions. The patient is not in the same position or alignment for both studies, patient movement is different during two separate imaging sessions as well as the involuntary and uncontrollable motion of internal organs. The other method uses a single combination PET/CT scanner that takes simultaneous PET and CT images. When compared to PET studies performed alone, using the co-registered images of a single combined PET/CT study improves lesion classification and staging performance, and reduces scanning time. In this situation, the patient remains positioned on the same bed for both imaging modalities, minimizing both temporal, motion and spatial differences between the images acquired. In addition, using the single scan for both modalities makes the images available for viewing while the patient is still in the scanner. For additional information on CT scans, refer to Mountain State Medical Policy Bulletin X-3. For additional information on PET tumor localization, refer to Mountain State Medical Policy Bulletin R-9. |
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| 78814 | 78815 | 78816 |
PRN References |
PET/CT Fusion Proves Its Value, Diagnostic Imaging, Vol. 24, No. 6, June 2002 |
Eligible Diagnosis Codes by Anatomic Area Brain
Breast
Colorectal
Esophageal
Head & Neck
Lung
Lymphoma
Melanoma
Pancreas
Thyroid
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