Current Medicare indications for all diagnostic imaging including PET scans can always be found at www.mbsonline.gov.au

PET scans fall under item numbers 61523 – 61647.

• 61523 – Whole body FDG PET study, performed for evaluation of a solitary pulmonary nodule where the lesion is considered unsuitable for transthoracic fine needle aspiration biopsy, or for which an attempt at pathological characterisation has failed.
• 61524 – Whole body FDG PET study, performed for the staging of locally advanced (Stage III) breast cancer, for a patient who is considered suitable for active therapy
• 61525 – Whole body FDG PET study, performed for the evaluation of suspected metastatic or suspected locally or regionally recurrent breast carcinoma, for a patient who is considered suitable for active therapy
• 61527 – Whole body study using PET, if the service is performed because the services to which items 61429, 61430, 61442, 61450 or 61453 apply cannot be performed due to the unavailability of gallium-67
• 61529 – Whole body FDG PET study, performed for the staging of proven non-small cell lung cancer, where curative surgery or radiotherapy is planned
• 61538 – FDG PET study of the brain for evaluation of suspected residual or recurrent malignant brain tumour based on anatomical imaging findings, after definitive therapy (or during ongoing chemotherapy) in patients who are considered suitable for further active therapy
• 61541 – Whole body FDG PET study, following initial therapy, for the evaluation of suspected residual, metastatic or recurrent colorectal carcinoma in patients considered suitable for active therapy
• 61553 – Whole body FDG PET study, following initial therapy, performed for the evaluation of suspected metastatic or recurrent malignant melanoma in patients considered suitable for active therapy
• 61559 – FDG PET study of the brain, performed for the evaluation of refractory epilepsy which is being evaluated for surgery

• 61560 – FDG PET study of the brain, performed for the diagnosis of Alzheimer’s disease, if:

a) clinical evaluation of the patient by a specialist, or in consultation with a specialist, is equivocal; and
b) the service includes a quantitative comparison of the results of the study with the results of an FDG PET study of a normal brain from a reference database; and
c) a service to which this item applies has not been performed on the patient in the previous 12 months; and
d) a service to which item 61402 applies has not been performed on the patient in the previous 12 months for the diagnosis or management of Alzheimer’s disease

• 61563 – Whole body prostate-specific membrane antigen PET study performed for the initial staging of intermediate to high-risk prostate adenocarcinoma, for a previously untreated patient who is considered suitable for locoregional therapy with curative intent (Benefits are only payable for a maximum of one service in the patient’s lifetime).
  The requesting physician is to record in the clinical notes of the request that the patient;
  • Has intermediate to high-risk prostate adenocarcinoma , as defined by having at least one of the following risk factors; PSA of 10-20 ng/mL, or Gleason score >7 / ISUP grade group 4 or 5, or Stage T2c or ≥ T3
  • has previously been untreated
  • is considered suitable for locoregional therapy

• 61564 – Whole body prostate-specific membrane antigen PET study performed for the restaging of recurrent prostate adenocarcinoma, for a patient who:

(a) has undergone prior locoregional therapy; and

(b) is considered suitable for further locoregional therapy to determine appropriate therapeutic pathways and timing of treatment initiation (Benefits are only payable for a maximum of two services in the patient’s lifetime)

This item can be claimed by patients with

○ a PSA increase of 2ng/mL above the nadir after radiation therapy; or

○ failure of PSA levels to fall to undetectable levels or rising serum PSA after a radical prostatectomy

• 61565 – Whole body FDG PET study, following initial therapy, performed for the evaluation of suspected residual, metastatic or recurrent ovarian carcinoma in patients considered suitable for active therapy
• 61571 – Whole body FDG PET study, for the further primary staging of  patients with histologically proven carcinoma of the uterine cervix, at FIGO stage IB2 or greater by conventional staging, prior to planned radical radiation therapy or combined modality therapy with curative intent
• 61575 – Whole body FDG PET study, for the further staging of patients with confirmed local recurrence of carcinoma of the uterine cervix considered suitable for salvage pelvic chemoradiotherapy or pelvic exenteration with curative intent
• 61577 – Whole body FDG PET study, performed for the staging of proven oesophageal or GEJ carcinoma, in patients considered suitable for active therapy
• 61598 – Whole body FDG PET study performed for the staging of biopsy-proven newly diagnosed or recurrent head and neck cancer
• 61604 – Whole body FDG PET study performed for the evaluation of patients with suspected residual head and neck cancer after definitive treatment, and who are suitable for active therapy
• 61610 – Whole body FDG PET study performed for the evaluation of metastatic squamous cell carcinoma of unknown primary site involving cervical nodes

• 61612 – Whole body FDG PET study for the initial staging of cancer, for a patient who is considered suitable for active therapy, if:

(a) the cancer is a typically FDG-avid cancer; and
(b) there is at least 10% likelihood that a PET study result will inform a significant change in management for the patient
(Applicable once per cancer diagnosis)

• 61614 – Whole body FDG PET study, following initial therapy, performed for the evaluation of suspected residual, metastatic or recurrent cancer in a patient who is undergoing, or is suitable for, active therapy, if the cancer is a typically FGD-avid cancer
• 61620 – Whole body FDG PET study for the initial staging of newly diagnosed or previously untreated Hodgkin or non-Hodgkin lymphoma
• 61622 – Whole body FDG PET study to assess response to first line therapy either during treatment or within three months of completing definitive first line treatment for Hodgkin or non-Hodgkin lymphoma
• 61628 – Whole body FDG PET study for restaging following confirmation of recurrence of Hodgkin or non-Hodgkin lymphoma
• 61632 – Whole body FDG PET study to assess response to second-line chemotherapy if haemopoietic stem cell transplantation is being considered for Hodgkin or non-Hodgkin lymphoma
• 61640 – Whole body FDG PET study for initial staging of patients with biopsy-proven bone or soft tissue sarcoma (excluding gastrointestinal stromal tumour) considered by conventional staging to be potentially curable
• 61646 – Whole body FDG PET study for the evaluation of patients with suspected residual or recurrent sarcoma (excluding gastrointestinal stromal tumour) after the initial course of definitive therapy to determine suitability for subsequent therapy with curative intent
• 61647 – Whole body ⁶⁸Ga DOTA peptide PET study, if:
  1. a gastro entero pancreatic neuroendocrine tumour is suspected on the basis of biochemical evidence with negative or equivocal conventional imaging; or
  2. both:
     • a surgically amenable gastro entero pancreatic neuroendocrine tumour has been identified on the basis of conventional techniques; and
     • the study is for excluding additional disease sites

• 61530 – Whole body 68Ga DOTA peptide study for:

a)     staging of histologically confirmed neuroendocrine neoplasm (NEN) or
b)    evaluation of somatostatin receptor expression of histologically confirmed and inoperable NEN under consideration for peptide-receptor radionuclide therapy (PRRT) or
c)     evaluation of response to PRRT therapy or
d)    evaluation of suspected recurrent or metastatic disease in known somatostatin receptor positive NEN