Billing and Coding: Positron Emission Tomography Scans Coverage - R29 - 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: Updated the language in Paragraph 2 to provide what documentation for coverage and the diagnosis codes to bill outside of a clinical trial and removed documentation criteria from the Beta Amyloid Gr 4 Paragraph per NCD 220.6.13 and CR12376. Deleted the Group 2 DX codes G30.0, G30.1, G30.8, G31.09, G31.1, G31.84, G31.85, G40.011, G40.019, G40.111, G40.119, G40.211, G40.219, G40.301, G40.311, G40.319, G40.A01, G40.A09, G40.A11, G40.A19, G40.B11, G40.B19, G40.411, G40.419, G40.803, G40.804, G40.813, G40.814, G40.823, G40.824, G40.89, G40.911, G40.919, R41.1 in the ICD-10 Codes That Support Medical Necessity section per CR12376.

Changed Group 3 Paragraph and Codes to the coverage & diagnosis codes criteria for NCD 220.6.9 FDG PET for Refractory Seizures and added the diagnosis codes from Group 2 that apply to this NCD. These are G40.011, G40.019, G40.111, G40.119, G40.211, G40.219, G40.301, G40.311, G40.319, G40.A01, G40.A09, G40.A11, G40.A19, G40.B11, G40.B19, G40.411, G40.419, G40.803, G40.804, G40.813, G40.814, G40.823, G40.824, G40.89, G40.911 and G40.919.

Renumber the succeeding Groups to 4-18.

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

 

            Last Updated Wed, 27 Oct 2021 20:26:39 +0000