Billing and Coding: Positron Emission Tomography Scans Coverage - R25 - Effective April 01, 2021

This coverage article has been revised and published for notice under contract numbers: 02101 (AK), 02201 (ID), 02301(OR), 02401 (WA), 03101 (AZ), 03201 (MT), 03301 (ND), 03401 (SD), 03501 (UT), and 03601 (WY).

Effective Date: April 01, 2021

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

  • Group 1 HCPCS Codes added and deleted:
    • Added A9592- Copper Cu64 Dotatate, 1 millicurie, and
    • Deleted C9068 - Copper Cu64 Dotatate diagnostic, 1 millicurie in the OPPS setting.
  • In the Group 13 Paragraph:
    • Corrected the CR number from CR 9861 to CR 11907.
  • In the Group 14 Paragraph:
    • Corrected CR 9861 to CR 12029, and
    • Replaced HCPCS codes A9897 - Positron Emission Tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified with A9592 - Copper Cu64 Dotatate, 1 millicurie and deleted C9068 - Copper Cu64 Dotatate, 1 millicurie.

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            Last Updated Tue, 04 May 2021 21:14:41 +0000