Single Photon Emission Computed Tomography (SPECT) — NCD 271 | CMS Coverage Update

TL;DR: The Centers for Medicare & Medicaid Services modified NCD 271 governing SPECT coverage, with an effective date of January 9, 2026. Here's what billing teams need to know.

CMS SPECT coverage policy under NCD 271 Medicare has been updated. This National Coverage Determination covers single photon emission computed tomography — a nuclear imaging modality used across cardiology, orthopedics, and oncology. The policy does not list specific CPT or HCPCS codes, which puts more weight on your MAC's local rules and your documentation of medical necessity.

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Quick-Reference Table

Field	Detail Copy
Payer	CMS / Centers for Medicare & Medicaid Services
Policy	Single Photon Emission Computed Tomography (SPECT)
Policy Code	NCD 271
Change Type	Modified
Effective Date	January 9, 2026
Impact Level	Medium
Specialties Affected	Cardiology, Nuclear Medicine, Orthopedics, Oncology, Radiology
Key Action	Audit your SPECT claims against NCD 271 indications and confirm MAC-level frequency rules before January 9, 2026

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CMS SPECT Coverage Criteria and Medical Necessity Requirements 2026

NCD 271 is the National Coverage Determination governing Medicare coverage of single photon emission computed tomography. The Centers for Medicare & Medicaid Services recognizes SPECT as covered under the Diagnostic Tests benefit category when used for specific, documented clinical indications.

The covered indications for SPECT under this coverage policy are:

Medical necessity drives every clean claim here. Your documentation must connect the patient's clinical presentation to one of these covered indications. A claim that doesn't tie the SPECT to a recognized indication under NCD 271 is a claim denial waiting to happen.

The policy does not mention prior authorization as a national requirement. But prior auth requirements can exist at the MAC level, so confirm with your local Medicare Administrative Contractor before assuming none applies to your region.

Frequency limitations are not set at the national level under this policy. CMS explicitly delegates frequency decisions to Medicare Administrative Contractor (MAC) discretion. That matters for your billing team — what's acceptable in one jurisdiction may trigger a review flag in another. Pull your MAC's local coverage determination (LCD) for SPECT and compare it against your claim volume before the effective date.

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CMS SPECT Exclusions and Non-Covered Indications

The one hard restriction in this policy involves the sequencing of SPECT and FDG PET for myocardial viability. Get this wrong and you're looking at a claim denial with no good argument to appeal.

Here's the rule: If a SPECT for myocardial viability comes back inconclusive, CMS permits the use of FDG positron emission tomography (PET) as a follow-up. That sequence — SPECT first, then FDG PET if inconclusive — is covered.

The reverse is not. If an FDG PET for myocardial viability is inconclusive, CMS does not cover SPECT as the follow-up test. Period. The policy is explicit on this point.

This is a sequencing rule, not a clinical one. The patient's condition doesn't change — but the order of tests determines whether CMS pays. Your cardiology and nuclear medicine teams need to know this rule before they order. Retroactive justification doesn't work here.

If you're billing for both SPECT and PET in a myocardial viability workup, your compliance officer should review the order of services before you submit. A mismatch between the test sequence in the chart and the NCD rule will cost you the reimbursement — and potentially trigger a broader audit.

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Coverage Indications at a Glance

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CMS SPECT Billing Guidelines and Action Items 2026

The absence of specific CPT or HCPCS codes in NCD 271 is the real issue here. CMS sets the coverage framework, but your MAC fills in the billing details. That gap between national policy and local rules is where claims fall apart.

Here's what your billing team should do before January 9, 2026:

Copy Action Items

If you handle high volumes of nuclear cardiology or musculoskeletal imaging, talk to your compliance officer before January 9, 2026. The sequencing rule and the MAC-discretion frequency limits create real financial exposure at scale.

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CPT, HCPCS, and ICD-10 Codes for SPECT Under NCD 271

Covered CPT Codes (When Selection Criteria Are Met)

The policy data for NCD 271 does not list specific CPT or HCPCS codes. CMS has not enumerated billing codes within this NCD.

What this means for SPECT billing: You need to confirm the applicable codes — and any code-level restrictions — directly with your Medicare Administrative Contractor. SPECT procedures are typically billed under nuclear medicine CPT codes (the 78000-78099 range for nuclear medicine and the 78300-78399 range for bone and joint imaging), but this blog post will not list specific codes that are not in the policy data. Using codes that your MAC doesn't recognize for SPECT, or codes that don't align with the clinical indications in NCD 271, creates claim denial risk that's entirely avoidable.

Contact your MAC's provider outreach line or pull their LCD to get the exact codes they expect for each covered indication before January 9, 2026.

Not Covered / Experimental Codes

No codes are listed in the policy for non-covered indications. The one explicit exclusion — SPECT following inconclusive FDG PET for myocardial viability — should be handled by not billing SPECT in that sequence, not by applying a specific "not covered" code.

Key ICD-10-CM Diagnosis Codes

NCD 271 does not list ICD-10-CM codes. Your MAC's LCD will specify which diagnosis codes support medical necessity for each SPECT indication. Pull that list and map it to the six covered indications from NCD 271 before the effective date.

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