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Updated eviCore Oncology Guidelines Cover Only FDG for PET Imaging

October 7, 2016

What is the news?

  • eviCore, one of the leading medical benefits management companies in the U.S., has updated its coding recommendations for PET imaging in oncology and imaging in prostate cancer.
  • Per this decision, eviCore will cover only FDG – not fluciclovine, choline, or Ga DOTATATE – for oncologic PET imaging.
  • The draft guidelines state that “PET imaging (including 18F-FDG, 18F-NaF, and 11C-Choline) is considered investigational and experimental for all indications for prostate cancer at this time.”

Why does it matter?

  • eviCore processes 12 million claims annually.
  • This decision could deprive patients of access to FDA-approved, commercially available, and highly valuable PET diagnostic imaging procedures that may detect and localize cancers more effectively than current modalities such as CT and/or MRI.

What is SNMMI doing?

What’s next?

  • SNMMI is closely monitoring the issue and will keep members informed of any new developments.