December 01, 2023

CMS Releases Instructions to Implement Beta-Amyloid PET Imaging Policy

The Centers for Medicare and Medicaid Services (CMS) released an MLN Matters article MM13429 to notify physicians, hospitals and other providers billing Medicare Administrative Contractors (MACs) of its decision to retire National Coverage Determination (NCD) 220.6.20. As a result of this NCD reconsideration, CMS is ending coverage with evidence development (CED), removing the once-in-a-lifetime requirement for PET beta-amyloid imaging, and permitting Medicare coverage determinations for PET beta-amyloid imaging to be made by the MACs. As previously reported, CMS believes there will be consistent coverage across regions for appropriate Medicare patients, based on the evidence. The American College of Radiology® (ACR®) supports these final changes in coverage and hopes it will allow patients greater access to amyloid PET scans for Alzheimer’s disease diagnosis, management and evaluation of newly approved therapies.

Effective for claims with dates of service on and after Oct. 13, 2023, MACs will make coverage determinations for PET beta-amyloid imaging for dementia and neurodegenerative disease NCD 220.6.20. The contractors have until Dec. 19, to implement this policy change.

CMS indicates in transmittal 12364 that effective for claims with dates of service on and after Oct. 13, contractors will adjust any PET beta-amyloid claims processed incorrectly that are brought to their attention. Providers and/or billing and coding staff need to contact their MAC to clarify billing requirements for Beta Amyloid Positron Emission Tomography (PET) in dementia and neurodegenerative disease.

CMS Resources

If you have questions about the final coverage decision or the NCD process, contact Alicia Blakey, ACR Principal Economic Policy Analyst.