BlueCross BlueShield of Tennessee Medical Policy Manual

Positron Emission Tomography (PET) for Miscellaneous Applications

DESCRIPTION

Positron emission tomography (PET) images biochemical reactions and physiological functions by measuring concentrations of radioactive chemicals that are partially metabolized in the body region of interest. Radiopharmaceuticals or tracers used for PET are introduced into the body by intravenous injection or by respiration.

The scanners used for PET imaging are very similar to those used for radiograph computed tomography, but PET requires more complicated technology and computerized mathematical models of physiologic functions and tracer kinetics for the generation of images.

POLICY

See also:

IMPORTANT REMINDERS

SOURCES

American College of Radiology (ACR). (2012). ACR appropriateness criteria ® seizures – child. Retrieved October 26, 2017 from the National Guideline Clearinghouse. (NGC: 009667).

American College of Radiology (ACR). (2014). ACR appropriateness criteria ® seizures and epilepsy. Retrieved October 26, 2017 from the National Guideline Clearinghouse. (NGC: 010452).

Harden, C., Huff, J., Schwartz, T., Dubinsky, R., Zimmerman, R., Weinstein, S., et al. (2007). Reassessment: neuroimaging in the emergency patient presenting with seizure (an evidence-based review). Neurology, 69, 1772-1780. (Level 1 evidence)

Krumholz, A., Wiebe, S., Gronseth, G., Shinnar, S., Levisohn, P., Ting, T., et al. (2007). Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review).  Neurology, 69 (21), 1996-2007. (Level 1 evidence)

Ramey, W., Martirosvan, N., Lieu, C., Hasham, H., Lemole, G., & Winand, M. (2013). Current management and surgical outcomes of medically intractable epilepsy. Clinical Neurology and Neurosurgery, 115 (12), 2411-2418. Abstract retrieved October 26, 2017 from PubMed database.

St Louis, E., & Cascino, G. (2016). Diagnosis of epilepsy and related episodic disorders. Continuum, 22 (1), 15-37. Abstract retrieved October 26, 2017 from PubMed database.

ORIGINAL EFFECTIVE DATE:  12/1992

MOST RECENT REVIEW DATE:  3/1/2018

ID_EC

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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