NCD 220.6.17: Positron Emission Tomography (PET) for Alzheimer's Disease
Medicare covers amyloid PET imaging for Alzheimer's via Coverage with Evidence Development (CED) since the 2024 NCD update, expanding from the prior single-scan-per-lifetime limit.
What's covered
- Amyloid PET scan for patients meeting cognitive/clinical criteria
- Multiple scans permitted in approved CED studies
- Imaging at qualified facilities
Coverage criteria
- Mild cognitive impairment or dementia consistent with AD
- Imaging would change management
- Performed at qualified facility with proper interpretation
Exclusions
- Routine screening of asymptomatic individuals
- Non-CED clinical use beyond single lifetime scan (historically)
Common denial patterns
- Lacks documentation that imaging would affect management
- Not in CED study but multiple scans billed
- Facility not on approved list
Appeal citation
NCD 220.6.17 (PET for AD), revised 2024 to expand coverage via CED.
Frequently asked questions
What does Medicare NCD 220.6.17 cover?
Medicare covers amyloid PET imaging for Alzheimer's via Coverage with Evidence Development (CED) since the 2024 NCD update, expanding from the prior single-scan-per-lifetime limit.
What are the coverage criteria?
Mild cognitive impairment or dementia consistent with AD; Imaging would change management; Performed at qualified facility with proper interpretation.
What is excluded?
Routine screening of asymptomatic individuals; Non-CED clinical use beyond single lifetime scan (historically).
How do I cite this NCD in an appeal?
NCD 220.6.17 (PET for AD), revised 2024 to expand coverage via CED.
Sources
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