MEDICAL POLICY DETAILS Medical Policy Title Positron Emission Tomography (PET) Oncologic Applications Policy Number 6.01.29 Category Technology Assessment Original Effective Date 11/18/99 Committee Approval Date 04/19/00, 04/19/01, 01/17/02, 10/16/02, 01/16/03, 08/21/03, 05/19/04, 08/18/05, 03/16/06, 04/19/07, 09/20/07, 08/21/08, 11/19/09, 04/22/10, 04/21/11, 09/20/12, 08/15/13, 04/17/14, 04/16/15, 04/21/16, 01/19/17, 12/21/17, 10/18/18, 06/20/19, 05/21/20, 05/20/21, 09/16/21, 03/24/22, 09/15/22, 08/17/23, 01/18/24 Current Effective Date 04/15/24 Archived Date N/A Archive Review Date N/A Product免责声明•服务取决于合同;如果产品不包括服务的承保范围,则不涵盖它,并且不适用医疗政策标准。•如果商业产品(包括基本计划或儿童健康以及产品),则适用医疗政策标准。•如果医疗补助产品涵盖特定服务,并且没有纽约州医疗补助指南(EMEDNY)标准,则医疗政策标准适用于该福利。•如果Medicare产品(包括Medicare HMO Dual Special Suelds Program(DSNP)产品)涵盖了一项特定的服务,并且没有用于该服务的国家或地方Medicare覆盖范围的决定,则医疗政策标准适用于该福利。•如果Medicare HMO Dual特殊需求计划(DSNP)产品不涵盖特定服务,请参阅Medicaid产品覆盖范围。