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39.3.2.2 Tumor Imaging
Tumor-imaging PET scans are a benefit and are limited to staging and restaging of recurrent tumors in which the PET scan may assist in determining the optimal clinical management of the client.
Procedure codes 4/I/T-78459, 4/I/T-78491, and
4/I/T-78492 are not a benefit of the Texas Medicaid Program.
When requesting prior authorization for tumor-imaging PET scans, the provider must submit supporting documentation which indicates that standard imaging was not conclusive and that the provider's rationale for this procedure supports medical necessity.
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