Cardiology Question for the Week of May 13, 2019

Cardiology Compliance Question of the Week


Does Medicare cover cardiac positron emission tomography (PET) scans for sarcoidosis (inflammation of the heart)?


There is no national coverage determination for PET for any kind of inflammation. Sarcoid is not one of the reasons the Centers for Medicare & Medicaid Services (CMS) give for coverage of cardiac PET. However, at least one Medicare Administrative Contractor (MAC), First Coast, will cover fluorodeoxyglucose (FDG) PET to evaluate for cardiac involvement in sarcoidosis if the patient has cardiomyopathy and is unable to undergo magnetic resonance imaging (MRI) scanning. Examples of patients who are unable to undergo MRI include, but are not limited to, patients with pacemakers, automatic implantable cardioverter defibrillators (AICDs), or other metal implants. First Coast requires the following diagnosis codes for PET for sarcoidosis: I43 —cardiomyopathy in diseases classified elsewhere, and either D86.85—sarcoid myocarditis—or D86.9—sarcoidosis, unspecified.