All PlansCoverageMedium impact
Cardiac Applications of PET Scanning
Blue Cross & Blue Shield of Mississippi·MS · Nuclear Medicine, Radiology, Cardiology·Medical Policy
We identified it
Jun 20, 2026
Summary
This is a new medical policy (A.6.01.20) establishing coverage criteria for cardiac PET scanning applications. The policy defines when cardiac PET scans are considered medically necessary for myocardial perfusion studies and viability assessment, including specific patient selection criteria based on CAD risk levels and body habitus considerations.
Action Required
Immediately: Review current cardiac PET scan authorization processes to ensure compliance with new policy A.6.01.20. Billing team must verify that cardiac PET scan requests meet the established criteria: intermediate CAD risk patients (25-75% disease probability), patients with indeterminate SPECT scans, or patients with BMI ≥40 or other conditions making SPECT suboptimal. Update prior authorization documentation to include pretest CAD probability assessment and justification for PET over SPECT imaging.