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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

January 2013

Payment Policy Update: Positron Emission Tomography (PET) Scans

Harvard Pilgrim has updated the list of covered clinical indications for positron emission tomography (PET) scans, effective for dates of service beginning April 1, 2013.

Harvard Pilgrim reimburses contracted providers for positron emission tomography (PET) scans performed on FDA-approved equipment at contracted facilities and PET imaging centers. Harvard Pilgrim’s PET policy is managed through an arrangement with National Imaging Associates, Inc. (NIA). NIA completed its annual guideline update recently, and multiple changes will be made to the PET payment policy based on their recommendations and current clinical evidence.

For brain/neurology PET scans, Harvard Pilgrim will reimburse for 11 previously uncovered indications. For oncology PET scans, Harvard Pilgrim will no longer reimburse for 31 previously covered indications. For complete information on each procedure, including a full list of covered ICD-9 diagnosis codes, see the updated Positron Emission Tomography (PET) Scans Payment Policy. For additional information, see Harvard Pilgrim’s Outpatient Advanced Imaging Authorization policy.

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Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network and Product Development

Joann Peck,
Manager, Network Planning and Administration

Annmarie Dadoly,

Kristin Edmonston,
Production Coordinator