Single Photon Emission Computed Tomography (SPECT) (CPB 0376, reviewed 2026-05-28)

Immediately: Billing team must implement prior authorization requirements for all SPECT procedures before claim submission. (1) Update billing system to route SPECT claims to Aetna precertification portal using CPT code search tool to determine precertification status by specific code. (2) Educate providers and clinical staff on Aetna's medical necessity criteria for non-cardiac SPECT indications (osteomyelitis assessment, spondylolysis detection, hemangioma diagnosis, PE diagnosis, brain tumor differentiation, Parkinson's vs essential tremor distinction, fever of unknown origin, parathyroid imaging, liver metastases/tumors, abscess localization, lymphoma staging, neuroendocrine tumors, seizure focus detection, thyroid cancer staging). (3) For cardiac SPECT: Direct all requests to eviCore Healthcare Cardiac Imaging Clinical Guidelines for appropriateness determination; ensure providers reference eviCore guidelines before ordering. (4) For parathyroid imaging: Require documentation of enlarged gland/hyperplasia/suspected adenoma AND lab evidence (PTH >55 pg/ml AND serum calcium >10.2 mg/dL) for SPECT-CT fusion approval. (5) Implement denial protocols for experimentally-designated procedures: cardiac SPECT for routine post-PTCA/CABG screening, pre-surgical asymptomatic screening, low-risk patient screening, transplant rejection detection, vulnerable plaque assessment, and acute MI immediate post-thrombolytic evaluation; non-cardiac SPECT for psychiatric disorders (schizophrenia, autism, ADHD, personality disorders), stroke, lung/ovarian cancer diagnosis, carotid stenosis, eating disorders, and pre-diagnostic Parkinson's imaging. (6) Consequences: Claims submitted without required prior authorization or for non-covered indications will be denied and require resubmission or appeal.