Coverage of Conditions and Treatments (Coverage Decisions)

Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.

List also available in PDF format.

Archived Coverage Decisions.

See Treatment Guidelines and Resources for additional information.

Coverage decision

Functional neuroimaging for primary degenerative dementia or mild cognitive impairment is not covered. This coverage decision involves the following functional neuroimaging technologies:Positron Emission Tomography (PET), Single Photon Emission Computed Tomography (SPECT), and Functional Magnetic Resonance Imaging (fMRI).

Note: Other emerging functional neuroimaging technologies, such as β-amyloid PET imaging, were not reviewed. The use of those technologies for primary degenerative dementia or mild cognitive impairment may be reviewed and authorized where appropriate on a case by case basis.

Background Policy Information

The State Health Technology Clinical Committee (HTCC) reviewed Functional neuroimaging for primary degenerative dementia or mild cognitive impairment on January 16, 2015. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that functional neuroimaging for primary degenerative dementia or mild cognitive impairment is not a covered benefit. Complete information on this HTCC determination is available here: What we're working on | Washington State Health Care Authority

Billing codes

CPT code: 70554, 70555, 78607 and 78608