Precertification Requirement for Positron Emission Tomography (PET) Scan

As a reminder, positron emission tomography (PET) scan, requires precertification as of January 1, 2020. Benefit determinations are made based on the medical policy in effect at the time of service and are available for review at www.bcbsnd.com/providers/policies-precertification.

To support quality member care and ensure our members are receiving medically necessary and appropriate care, it is Blue Cross Blue Shield of North Dakota’s (BCBSND) expectation that providers submit documentation specific to the service/procedure requested. This documentation helps ensure that appropriate determinations are made for your request. Documentation should support the individualized care and support the criteria in the applicable policy.

PET scan documentation should include pertinent information such as:

  • Type of cancer being treated
  • When the condition was diagnosed
  • Treatment received (surgery, chemotherapy, radiation or combination)
  • Last PET scan date, including results (any new lesions found)
  • Any other imaging done—include date and results
  • Any new signs and symptoms reported by the patient or found in a clinical exam