The coverage requirements for the Billing and Coding: Positron Emission Tomography Scans Coverage National Coverage Determination (NCD): 01112 (NCA), 01182 (SCA), 01212 (HI and Territories), and 01312 (NV).

NCD: Billing and Coding: Positron Emission Tomography Scans Coverage - NCD Number 220.6.17

Effective Date: July 1, 2021

Summary of Article Changes: The following information was added in CPT/HCPCS Codes CPT/ HCPCS Modifiers and the ICD-10 Codes that Support Medical Necessity.

• Added HCPCS codes A9593 and A9594 for Gallium ga-68 psma-11 (UCSF) and Gallium ga-68 psma-11 (UCLA) respectively for the treatment of prostate cancer per CR12142 to Group 15. Added HCPCS code A9597 for piflufolastat F 18 (PYLARIFY®) to Group 16 effective 5/26/2021.
• Added Q0 and Q1 modifiers to the CPT/HCPCS Modifiers section.
• Updated formatting in both the CPT/HCPCS Codes and ICD-10 Codes that Support Medical Necessity sections.
• Added the following statement in the current Revision History section.
  • “Note: The effective date for the information in Revision History number 23 for CR 12027 is 04/01/2021 and not 10/01/2020 as indicated.”

Visit the National Coverage Determination (NCD) webpage to view the locally hosted NCD coverage requirement articles.

To access a complete list of CMS NCDs, visit the National Coverage Determinations (NCDs) Alphabetical Index.