2020 PET scan criteria from NIA Magellan

Date: 12/13/19

National Imaging Associates, INC, (NIA) have updated guidelines for Brain PET scans and Oncology PET
Scans, that will be in effect 1/1/2020.

The sections on the Brain PET scan have been updated are:

• Indication of main section to reflect the use of Fluourodeoxyglucose (FDG).
• Under the Mild Cognitive Impairment or Dementia section have added ‘Brain MRI to rule out
  structural causes or Brain CT if MRI is contraindicated.’

The Oncology PET Scan indications have been significantly updated. The key points of changes for
Oncology PET Scans are the following sections: Providers will need to review prior to ordering PET
Scans for Oncology:

• Under the section for noncovered for F18 FDG, Ga68 Dotatate, F18 Fluciclovine there has been
  significant number of cancers added to this list.
• Under the indications for oncological PET heading, providers will need to contact health plan
  directly for radiation treatment planning.
• Changes to CLL (chronic lymphocytic leukemia) PET/CT scan indications.
• Solid tumor initial staging indication section has been updated.
• Subsequent Treatment Strategy section has been updated.
• List of Cancers under subsequent imaging (without needing prior inconclusive imaging) has been
  changed.
• Subsequent PET scans needing prior inconclusive imaging have been modified.
• Changes to the indications related to thyroid Cancer.
• A new Pediatric cancer section has been added for indications different from the adult
  guidelines.
• Changes also made to the Gallium 68 Dotatate PET and the 18F-Fluciclovine PET/CT scans.