Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease (CAG-00431R)
Communicates CMS's removal of the NCD that limited PET beta amyloid imaging to coverage with evidence development and explains that Medicare Administrative Contractors and HealthPartners may now make local coverage decisions for beta amyloid PET imaging.
CMS removed the National Coverage Determination (NCD) at 8220.6.20 that previously allowed PET beta amyloid imaging only once per lifetime within the context of a clinical trial.
Medicare Administrative Contractors (MACs) may now make local coverage determinations for PET beta amyloid imaging; coverage by HealthPartners may be subject to MAC or HealthPartners requirements.
Coverage Criteria for Beta Amyloid PET Imaging
Local coverage determinations
Coverage stance is determined by local Medicare Administrative Contractors (MACs) and HealthPartners.
No specific clinical criteria are provided in this document; MACs and HealthPartners will define clinical and administrative requirements (for example, prior authorization or documentation) as applicable.
CMS has removed the National Coverage Determination (NCD) at 8220.6.20, which previously limited PET beta amyloid imaging to one lifetime scan performed only within the context of a clinical trial (Coverage with Evidence Development). With that NCD removed, Medicare Administrative Contractors (MACs) may now develop local coverage determinations for PET beta amyloid imaging under the Social Security Act. Coverage by HealthPartners for PET beta amyloid imaging may be provided when consistent with any requirements established by the applicable local MAC and/or HealthPartners.
This announcement does not list any conditions that are explicitly not medically necessary. Instead, determinations about medical necessity and any restrictions or exclusions for PET beta amyloid imaging will be made at the local level by Medicare Administrative Contractors (MACs) and by HealthPartners according to their respective coverage policies and requirements.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.