Appendix A

Effect of Coverage Changes on Oncologic Uses of FDG PET

See NCD Manual for specific coverage language

 

Solid Tumor Type

Initial Treatment Strategy*

Subsequent Treatment Strategy**

Colorectal

Cover

Cover

Esophagus

Cover

Cover

Head & Neck (not thyroid or CNS)

Cover

Cover

Lymphoma

Cover

Cover

Non-small cell lung

Cover

Cover

Ovary

Cover

Cover

Brain

Cover

Cover

Cervix

1 or CED

Cover

Small cell lung

Cover

CED

Soft Tissue Sarcoma

Cover

CED

Pancreas

Cover

CED

Testes

Cover

CED

Breast (female and male)

2

Cover

Melanoma

3

Cover

Prostate

N/C

CED

Thyroid

Cover

4 or CED

All other solid tumors

Cover

CEC

Myeloma

Cover

Cover

All other cancers not listed herein

CED

CED

 

*Formerly “diagnosis” and “staging”

**Formerly “restaging” and monitoring response to treatment when a change in treatment is anticipated”

CED = Coverage with Evidence Development

N/C = not covered

 

 


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