All PlansCoverageHigh impact
Oncologic Applications of Positron Emission Tomography (PET) Scanning
Blue Cross & Blue Shield of Mississippi·MS · Oncology, Radiology, Nuclear Medicine +4 more·Medical Policy
We identified it
Jun 20, 2026
Summary
This policy establishes coverage criteria for PET scans in oncology, specifying when different types of PET imaging are medically necessary versus investigational for various cancer types. The policy details approved radiopharmaceuticals and their specific indications, with particular focus on staging, restaging, and diagnosis applications.
Action Required
Immediately: Billing team must review all pending and future PET scan authorizations against the new medical necessity criteria. Update prior authorization workflows to verify cancer type, staging purpose (diagnosis, initial staging, restaging), and specific radiopharmaceutical being used. Train staff on the distinction between medically necessary applications (staging/restaging) versus investigational uses (surveillance, certain breast cancer applications). Ensure documentation clearly indicates the clinical purpose and cancer type to support medical necessity.