CommercialCoverageMedium impact
Positron Emission Tomography (PET) – Head Imaging 6.01.47
Excellus BlueCross BlueShield·Neurology, Radiology, Nuclear Medicine +1 more·Radiology (x-rays) & Imaging
Effective date
May 15, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated comprehensive coverage criteria for brain PET imaging procedures, establishing specific requirements for different types of cognitive assessments, dementia diagnosis, and neurological evaluations. The policy defines when FDG, Amyloid, and Tau PET brain imaging are medically necessary versus not covered.
Action Required
Before May 15, 2026: Billing team must update prior authorization requirements for brain PET imaging codes (78608, 78814, 78811, 78609) to ensure all specified clinical criteria are documented including cognitive testing scores, structural imaging results, and detailed symptom history. Update encounter forms to include required documentation checklists for dementia evaluation, MCI assessment, and neurological conditions. Claims without meeting the specific policy criteria will be denied.