Billing and Coding: Positron Emission Tomography Scans Coverage - R32 - Article effective February 18, 2022

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: February 18, 2022

Summary of Article Changes: In the Article Text deleted the statement “The section below is quoted from the IOM Medicare National Coverage Determinations (NCD) Manual, Publication 100-03, Chapter 1, Part 4, Section 220.6” per CR 12613 and changed formatting throughout the article text.

Under Indications and Limitations of Coverage in the Article Text, added the specific NCD numbers addressed in this article, added language indicating any uses of PET scans that are not specifically listed in the NCDs listed may be covered per local MAC discretion and removed NaF for PET imaging for oncologic conditions using the PI or PS modifier since this tracer is non-covered per NCD 220.6.19.

In the Group 6-10 Paragraphs under ICD-10-CM Codes that Support Medical Necessity, added A9552 as the tracer to use and clarified PS modifier is used for subsequent strategy.

In Group 10 Paragraph added Gallium 68- ga Gozetotide/PSMA-11 (Illuccix®), effective 12/17/2021 as a newly local contractor approved tracer.

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

            Last Updated Thu, 21 Apr 2022 13:02:47 +0000