PET/CT CPT Codes

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Neuro

CPT Code 78608

IMG 5021

Prep: A minimum fasting interval of 4 hours is recommended before the study.

Consult nuclear medicine physician if patient is diabetic.

Time in Department: 2 hours

  • Tumor, Metabolic Evaluation Brain FDG-PET imaging is primarily used for evaluation of patients with: suspected or proven brain tumors, to assess tumor grade, detect residual or recurrent brain tumor, and differentiate tumor from post-therapeutic changes; differentiating malignant from infectious central nervous system mass lesions (such as differentiation between lymphoma and toxoplasmosis) in patients with human immunodeficiency virus (HIV) infection.

CPT Code 78608

IMG 5006

Prep: A minimum fasting interval of 4 hours is recommended before the study.

Consult nuclear medicine physician if patient is diabetic.

Time in Department: 2 hours

  • Non-Tumor, Metabolic Evaluation Brain FDG-PET imaging is primarily used for evaluation of patients with: epilepsy, for detection of epileptogenic foci; symptoms (e.g., memory loss) consistent with an early stage of a progressive dementia, for purposes of distinguishing Alzheimer’s disease from other diseases causing dementia. It is less commonly used to evaluate for functional changes in brain metabolism in patients with suspected focal or diffuse organic brain disease but normal results of CT or MRI.

FDG PET/CT Brain Amyloid or NEW iDEAS Study    

CPT Code 78814

IMG 7669

Prep: No prep required for this study. If you are ordering an NEW iDEAS imaging study, the patient must be registered and consented for the NEW iDEAS study.

Please call the PET department for more information.

Time in Department: 2 hours

  • Brain amyloid PET imaging is indicated for the assessment of –amyloid neuritic plaque density in adults with cognitive impairment undergoing evaluation for the cause of their cognitive decline. Elevated levels of amyloid in the brain are a hallmark of Alzheimer’s disease (AD), and [F-18]fl orbetaben is an FDA-approved radiopharmaceutical for assessing amyloid plaques in the brain. A positive florbetaben-PET study indicates the presence of moderate or frequent neuritic plaques in the brain which occurs with AD but can be seen in other neurological disorders and in cognitively normal older individuals. A negative florbetaben-PET study indicates no or sparse neuritic plaques and reduces the likelihood that the patient’s cognitive impairment is due to AD.

Cardiac

CPT Code 78429

Prep: Since these exams are specific to patient disease, prep information for these exams will need to be provided by the PET department case-by-case.

Time in Department: 2-4 hours

  • IMG 50241 – Myocardial FDG-PET/CT (Sarcoidosis) is indicated for the detection of active cardiac involvement in patients with suspected or confirmed sarcoidosis.
  • IMG 50242 – Myocardial FDG-PET/CT (Viability) is indicated for the detection of viable myocardium in patients with coronary artery disease.

Code 78431

IMG 1133

Prep: Nothing to eat or drink for 6 hours. Sips of water are ok. No caffeine (coffee, cola, tea) for 12 hours before appointment time.

Time in Department: 2-4 hours

  • Cardiac stress-rest perfusion PET may be performed predominantly in patients with known or increased suspicion for multivessel CAD, advanced obesity, women of young age and/or certain body habitus, and suspicion for microvascular angina.
  • Concurrent quantification of myocardial blood flow (MBF) affords the assessment of hyperemic MBF during pharmacologic vasodilation and at rest and, thus, the computation of the myocardial flow reserve (MFR=MBFstress/MBF rest). The concurrent assessment of hyperemic MBF and/or MFR aids in the identification and characterization of multivessel CAD, microvascular dysfunction, and prognostication.

Tumor

CPT Code 78815

IMG 5012

Prep: A minimum fasting interval of 4 hours is recommended before the study. Consult the nuclear medicine physician if the patient is diabetic. The patient’s last meal prior to the PET study (which is typically the day before the study) should have a high protein and low carbohydrate content. Limit exercise the day before the PET scan appointment.

Time in Department: 2-3 hours

  • Body FDG-PET/CT imaging is indicated for evaluation of a variety of proven or suspected malignant neoplasms for addressing the following clinical problems: (1) differentiation of benign from malignant lesions, especially in lung; (2) initial staging of malignancies; (3) monitoring and assessment of response to therapy; (4) detection of residual or recurrent tumor following therapy; and (5) for detection of infection or inflammation.

CPT Code 78816

IMG 5017

Prep: A minimum fasting interval of 4 hours is recommended before the study. Consult the nuclear medicine physician if the patient is diabetic. The patient’s last meal prior to the PET study (which is typically the day before the study) should have a high protein and low carbohydrate content. Limit exercise the day before the PET scan appointment.

Time in Department: 2-3 hours

  • Body FDG-PET/CT imaging is indicated for evaluation of a variety of proven or suspected malignant neoplasms for addressing the following clinical problems: (1) differentiation of benign from malignant lesions, especially in lung; (2) initial staging of malignancies; (3) monitoring and assessment of response to therapy; (4) detection of residual or recurrent tumor following therapy; and (5) for detection of infection or inflammation.
  • Whole Body PET imaging is indicated for tumors of the lower extremities

CPT Code 78815, HCPCS Code A9587 (Ga-68), and HCPCS Code A9592 (Cu-64)

IMG 3284

Prep: A minimum fasting interval of 2 hours is recommended before the study.

Time in Department: 2-3 hours

  • Dotatate-PET/CT is indicated for evaluation of neuroendocrine tumors (NETs), which are neoplasms arising from neural crest tissue within the adrenal medulla, pituitary, parathyroid, thyroid, pancreas, respiratory tract, and gastrointestinal tract, for addressing the following clinical problems: (1) detection and characterization; (2) staging; (3) monitoring and assessing response to therapy; and (4) detection of residual or recurrent tumor following therapy (restaging).

CPT Code 78816, HCPCS Code A9587 (Ga-68), and HCPCS Code A9592 (Cu-64)

IMG 8998

Prep: A minimum fasting interval of 2 hours is recommended before the study.

Time in Department: 2-3 hours

  • Dotatate-PET/CT is indicated for evaluation of neuroendocrine tumors (NETs), which are neoplasms arising from neural crest tissue within the adrenal medulla, pituitary, parathyroid, thyroid, pancreas, respiratory tract, and gastrointestinal tract, for addressing the following clinical problems: (1) detection and characterization; (2) staging; (3) monitoring and assessing response to therapy; and (4) detection of residual or recurrent tumor following therapy (restaging).
  • Whole Body PET imaging is indicated for tumors of the lower extremities.

CPT Code 78815, HCPCS Code A9588 (FACBC) or A9515 (Choline)

IMG 5013

Prep: A minimum fasting interval of 4 hours, for FACBC, and 6 hours, for Choline is recommended before the study.

Time in Department: 1-2 hours

  • Prostate Cancer-PET/CT is indicated for detection of suspected recurrent prostate cancer in men with elevated blood prostate specific antigen (PSA) levels following prior treatment. Prostate Cancer-PET/CT also may be useful for initial stage of men with newly diagnosed prostate cancer at medium or high risk of locoregional or distant metastatic disease.

Musculoskeletal

CPT Code 78816, HCPCS Code A9580

IMG 5016

Prep: Drink 2 or more 8-oz glasses of water within 1 hour before the examination.

Time in Department: 2 hours

  • PET/CT imaging with [F-18]sodium fluoride (NaF-PET/CT) is indicated for evaluation of a variety of benign and malignant bone diseases for addressing the following clinical problems: (1) differentiation of benign from malignant bone lesions; (2) detection of bone metastasis (initial staging or restaging); (3) monitoring and assessing response to therapy of known bone metastasis; (4) evaluation of bone graft viability; (5) evaluation of benign bone tumors; (6) detection of osteomyelitis or discitis; (7) evaluation of prosthesis loosening; (8) evaluation of bone pain and (9) evaluation of osteonecrosis and fracture.

PET Radiopharmaceuticals

[F-18]fluoro-2-deoxy-D-glucose (FDG) is an analog of glucose and localizes in high concentration in some normal tissues (heart, brain, and liver) and most malignant tumors. Use of this imaging technique in oncology is based on the observation that malignant tissues have a higher uptake of FDG than do the surrounding normal tissues.

Ga-68 dotatate is an analog of somatostatin and localizes in high concentration in some normal tissues (spleen, adrenal glands, pituitary gland, kidneys, and bladder, and to a lesser extent in the liver, salivary glands and thyroid, and to a variable degree in the bowel) and in NETs that express a high density of somatostatin receptors. Uptake in the endocrine organs, salivary glands, and spleen is mediated by expression of somatostatin receptors, whereas uptake in the kidneys and liver is not. The peptide is small enough to be filtered through glomeruli, but is also partially reabsorbed in the proximal convoluted tubules, resulting in high activity in the renal collecting systems, ureters and bladder, as well as retained activity in the renal parenchyma.

Cu-64 dotatate binds to somatostatin receptors with highest affinity for subtype 2 receptors (SSTR2). It binds to cells that express somatostatin receptors including malignant neuroendocrine cells, which overexpress SSTR2 receptors. Uptake can also be seen in a variety of non-NET tumors that contain somatostatin receptors or as a normal physiologic variant. NET tumors that do not bear somatostatin receptors will not be visualized.

[F-18]fluciclovine (Anti-1-amino-3-fluorocyclobutane-1-carboxylic acid, FACBC, Axumin®) is a synthetic L-leucine analogue that is actively transported into mammalian cells by amino acid transporters, but is not then incorporated into newly synthesized proteins. Following injection, FACBC is preferentially taken up into cells/tissues with enhanced amino acid transport, such as tumor cells that require increased amounts of amino acids to support increased metabolism and proliferation. PET studies have demonstrated that FACBC is preferentially taken up into prostate carcinoma, breast cancer (especially lobular) and glioblastoma multiforme compared with surrounding normal tissue.

C-11 choline is chemically identical to choline that occurs naturally in the human body. C-11 choline has little urinary excretion, a property desirable for imaging the prostatic bed and pelvis. Choline is involved in synthesis of the structural components of cell membranes, as well as modulation of transmembrane signaling. Increased phospholipid synthesis (i.e., increased uptake of choline) has been associated with cell proliferation and malignant transformation. The diagnostic yield of C-11 choline PET is related to the serum PSA level and kinetics. C-11 choline PET is relatively insensitive in patients with biochemically recurrent prostate cancer after surgery with PSA values < 2 ng/mL.

In the bloodstream, N-13 ammonia consists of neutral NH3 in equilibrium with the charged ammonium ion (NH4+). N-13 ammonia clears rapidly from the circulation with a high first-pass myocardial extraction (approximately 80%) which decreases at higher blood flow rates. Its retention by the myocardium has a nonlinear and inverse relationship with blood flow. The myocardial uptake of N-13 ammonia is either through ATP dependent trapping in the cytoplasm as NH4+ or through passive diffusion if in neutral form as NH3. In the myocytes, N-13 ammonia is incorporated into the amino acid pool as N-13 glutamine and becomes metabolically trapped. Only a small fraction diffuses back into the blood.

[F-18]florbetaben is a stilbene derivative labeled with the positron-emitting isotope fluorine F 18, that may be used for positron emission tomography (PET) detection of beta-amyloid neuritic plaques and other amyloid protein deposits. Upon administration, F 18-florbetaben exhibits differential retention in regions that contain certain amyloid deposits. Differences in signal intensity between tissues showing specific and nonspecific uptake of F 18-florbetaben allows for the detection of amyloid neuritic plaques in patients being evaluated for Alzheimer’s disease, and potentially the detection of amyloid deposits in amyloidosis.

[F-18] sodium fluoride (NaF) is a positron-emitting bone seeking agent that localizes in high concentration in the skeleton. Its uptake mechanism resembles that of Tc-99m MDP. After intravenous administration, [F-18]fluoride ion diffuses through the capillaries into  the bone extracellular fluid.

Not all exams are available at all locations.