Billing and Coding: Positron Emission Tomography Scans Coverage - R28 - Article effective October 01, 2021

This coverage article has been revised and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (HI and Territories), and 01312 (NV).

Effective Date: October 01, 2021

Summary of Article Changes: Added the statement “Effective 09/10/2021, the NCCN Guidelines have been updated to allow PMSA-PET/CT or PMSA-PET/MRI with Ga-68 PSMA-11 to be considered effective for initial bone imaging with the use of the ‘PI’ modifier." to the Group 15 Paragraph and "Effective 09/10/2021, the National Comprehensive Cancer Network® (NCCN®) Guidelines have been updated to allow PMSA-PET/CT or PMSA-PET/MRI with F 18 piflufolastat PSMA to be considered effective for initial bone imaging with the use of the ‘PI’ modifier." to the Group 16 Paragraph. Also effective 9/10/2021, added the information for the tracers C-11 Choline from Group 10 and Fluciclovine F18 from Group 12 PET/CT or PET/MRI and the ‘PI’ modifier are allowed when equivocal results are on initial bone imaging per the updated NCCN Guidelines for Prostate Cancer.

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

            Last Updated Tue, 12 Oct 2021 18:18:17 +0000