Summary: The Centers for Medicare & Medicaid Services modified its beta amyloid PET coverage policy, effective May 15, 2026, retiring the existing national coverage framework for these scans in dementia and neurodegenerative disease. Here's what billing teams need to do before that date.
This is a significant shift in CMS beta amyloid positron emission tomography coverage policy. The Centers for Medicare & Medicaid Services is retiring the policy governing PET imaging for amyloid plaques in patients with dementia and neurodegenerative disease — a policy that has been one of the most closely watched and litigated coverage determinations in Medicare for over a decade. This policy does not list specific CPT or HCPCS codes in the available policy data, but beta amyloid PET billing touches codes that many neurology, radiology, and nuclear medicine practices bill regularly. If your team bills these scans for Medicare patients, this retirement changes your coverage landscape starting May 15, 2026.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS (Centers for Medicare & Medicaid Services) |
| Policy | Beta Amyloid Positron Tomography in Dementia and Neurodegenerative Disease (RETIRED) |
| Policy Code | N/A |
| Change Type | Modified — Policy Retired |
| Effective Date | May 15, 2026 |
| Impact Level | High |
| Specialties Affected | Neurology, Radiology, Nuclear Medicine, Geriatrics, Memory Care |
| Key Action | Audit all pending and scheduled beta amyloid PET claims before May 15, 2026, and confirm MAC-level local coverage determination guidance for your region |
CMS Beta Amyloid PET Coverage Criteria and Medical Necessity Requirements 2026
The CMS beta amyloid PET coverage policy has a long and complicated history. For years, Medicare covered these scans only under tightly controlled Coverage with Evidence Development (CED) requirements — meaning patients had to be enrolled in approved clinical trials or registries to get reimbursement. The Imaging Dementia–Evidence for Amyloid Scanning (IDEAS) study and its successor, the New IDEAS study, were the primary vehicles through which most beta amyloid PET scans got paid.
That CED framework was the source of enormous friction for billing teams. Prior authorization wasn't just recommended — it was effectively built into the coverage structure itself. Your team had to verify registry enrollment, confirm medical necessity criteria, and document that the scan result would change patient management. Missing any of those documentation requirements meant claim denial.
Now CMS is retiring the policy entirely. That's not the same as saying the scans are no longer covered. Policy retirement means the old national coverage determination framework goes away. What fills that void matters enormously for your billing guidelines going forward.
When a national policy retires, coverage decisions typically fall to Medicare Administrative Contractors at the regional level. Your MAC may issue a local coverage determination — an LCD — that governs whether beta amyloid PET scans are covered in your region, under what medical necessity criteria, and with what documentation requirements. Some MACs will move quickly. Others won't. In the interim, your team is operating in a coverage gray zone that carries real claim denial risk.
The medical necessity documentation requirements that existed under the old CED framework — cognitive decline evaluation, ruling out other causes, confirmation that diagnosis is uncertain — don't disappear just because CMS retired the national policy. Your MAC may adopt similar criteria. Or it may apply different standards. Until your regional MAC publishes formal LCD guidance, you're billing into uncertainty.
CMS Beta Amyloid PET Exclusions and Non-Covered Indications
Under the prior coverage policy, CMS was explicit about what didn't qualify. Beta amyloid PET was not covered for patients who already had a confirmed Alzheimer's diagnosis. It was not covered when the scan result wouldn't change clinical management. And it was not covered outside of the CED registry framework — meaning a scan ordered by a physician who simply thought it was clinically useful, without registry enrollment, was a non-covered service regardless of medical necessity.
Those exclusions made sense within the CED model. Retiring the policy doesn't eliminate those clinical realities. Payers — including Medicare — still expect that any covered diagnostic service changes patient care. If your documentation doesn't show why the scan was ordered, how the result was expected to change management, and what the clinical picture looked like before the scan, you're exposed to claim denial under any coverage framework that replaces this one.
Watch for your MAC to carry some version of these exclusions into any LCD it publishes. The clinical logic hasn't changed even if the coverage vehicle has.
Coverage Indications at a Glance
The available policy data does not include a detailed breakdown of covered and non-covered indications with specific criteria attached. The table below reflects the general coverage framework that governed beta amyloid PET under the retired CED model. Verify current guidance with your MAC before billing after May 15, 2026.
| Indication | Status Under Retired Policy | Notes |
|---|---|---|
| Cognitively impaired patients enrolled in approved CED registry | Covered | Registry enrollment was required for reimbursement; retiring the policy removes this framework |
| Beta amyloid PET outside approved registry | Not Covered | Scan ordered without CED enrollment was non-covered regardless of clinical need |
| Patients with confirmed Alzheimer's diagnosis | Not Covered | Scan had to be ordered when diagnosis remained uncertain |
| Asymptomatic patients | Not Covered | No coverage for screening in the absence of documented cognitive symptoms |
| Post-retirement coverage (after May 15, 2026) | MAC-Dependent | Regional LCD guidance will govern; contact your MAC for current determinations |
CMS Beta Amyloid PET Billing Guidelines and Action Items 2026
This retirement is one of those policy changes where doing nothing before the effective date is the highest-risk choice. Here's what your billing team needs to do now.
| # | Action Item |
|---|---|
| 1 | Identify every open beta amyloid PET claim in your system before May 15, 2026. Pull every claim that is pending, in process, or scheduled for a service date on or after the effective date. You need a complete picture before the policy retirement takes effect. |
| 2 | Contact your Medicare Administrative Contractor directly. Ask whether your MAC has issued or plans to issue a local coverage determination for beta amyloid PET. If an LCD exists, get the policy number and effective date. If one is pending, ask for the expected timeline. Don't rely on secondhand information — get it from the source. |
| 3 | Audit your documentation for medical necessity on all pending claims. The old CED framework required specific documentation. Any future LCD will require documentation too. Make sure your clinical notes show why the scan was ordered, what the diagnostic uncertainty was, and how the result would change patient management. |
| 4 | Do not assume the retired policy equals non-coverage. This is a common billing team mistake. A retired national policy means MAC-level rules apply — it does not mean the service is automatically non-covered. Billing a service as non-covered without checking your MAC's current guidance will cost you legitimate reimbursement. |
| 5 | Update your charge capture workflow to flag these scans for manual review. Until your MAC publishes clear LCD guidance, beta amyloid PET claims should not flow through your standard automated processes. Every claim needs eyes on it before submission. |
| 6 | Talk to your compliance officer before the effective date if you're uncertain how this applies to your patient mix. If your practice has a high volume of memory care or neurodegenerative disease patients, the financial exposure here is material. Your compliance officer needs to know this change is coming. |
| 7 | Watch for prior authorization requirement changes at the MAC level. The old CED registry enrollment functioned as a form of prior authorization. Your MAC's LCD may require a formal prior auth process that looks different. Update your front-end workflows accordingly. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Beta Amyloid PET Under This Policy
The available policy data does not list specific CPT, HCPCS, or ICD-10 codes. Do not assume which codes are affected without confirming against your MAC's current guidance and any LCD that replaces the retired national policy.
That said, beta amyloid PET billing historically involves PET scan procedure codes and radiopharmaceutical HCPCS codes for the amyloid-targeting tracers. The three FDA-approved tracers — florbetapir, florbetaben, and flutemetamol — each have corresponding HCPCS codes that your radiology or nuclear medicine team bills alongside the scan itself. These codes are the heart of beta amyloid PET billing, and they're precisely the codes where coverage determination matters most.
What to Do Without Code-Level Policy Data
Pull your MAC's published LCD (if available) and map the specific codes it covers to your current charge description master. If your MAC hasn't published guidance yet, identify the codes you currently bill for these scans and flag them for manual review on all claims dated May 15, 2026 or later. Your nuclear medicine billing team will know which tracer codes your facility uses — start there.
Do not use this post's code discussion as a substitute for the actual MAC policy document. The stakes here are too high for approximation.
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