CommercialCoverageMedium impact
Interim PET Scanning in Oncology to Detect Early Response During Treatment
Blue Cross & Blue Shield of Mississippi·MS · Oncology, Radiology, Nuclear Medicine·Medical Policy
We identified it
Jun 20, 2026
Summary
This policy clarifies that interim PET scans during cancer treatment are considered investigational and not covered for most cancers, except for gastrointestinal stromal tumors (GIST) on tyrosine kinase inhibitor treatment which is considered medically necessary.
Action Required
Immediately: Billing team must verify medical necessity for interim PET scans (CPT 78811-78816) during cancer treatment. Only approve claims for gastrointestinal stromal tumor patients on tyrosine kinase inhibitor treatment. All other interim PET scans during treatment are investigational and will be denied. Update prior authorization protocols accordingly.