News | October 07, 2009

New Instructions Released for April FDG-PET NCD Changes

October 7, 2009 - CMS recently released to the Medicare Administrative Contractors (MACs), via transmittals 1817 and 106, reissued Guidance and Billing Instructions for the April 2009 changes to the National Coverage Determination (NCD) on Positron Emission Tomography (FDG).

Providers will have two new modifiers (in addition to the list of current modifiers) to consider when submitting claims with a date of service (DOS) on or after April 6, 2009 for CPT codes 78608, 78811-78816 for oncologic procedures.

Available on or after the implementation date of October 19, 2009, providers submitting claims with a DOS on or after April 6, 2009 for CPT codes 78608, 78811-78816 are now required to identify the procedure as either for initial treatment strategy or subsequent treatment strategy by appending the modifiers PI or PS, respectively.

CMS removed the previously identified ICD-9 range of codes allowing discretion at the local level with the Medicare Contractors. CMS did identify the combination of PI and ICD-9 codes that are newly non-covered 185 for adenocarcinoma of prostate.

Providers participating in the national oncologic PET registry (NOPR) for those procedures which continue to be covered only under coverage with evidence development (CED) continue to use the Q0 (zero) modifier and/or V70.7 in the second diagnosis position with condition code 30 in addition to using one of the two new modifiers below.

New Modifiers for PET Effective for Dates of Services (DOS) on or after April 6, 2009 Implemented on or after October 19, 2009

PI – Positron Emission Tomography (PET) or PET/Computed Tomography (CT) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing. Short descriptor: PET tumor init tx strat

PS – Positron Emission Tomography (PET) or PET/Computed Tomography (CT) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the PET study is needed to inform subsequent anti-tumor strategy. Short descriptor: PET tumor subsq tx strategy

MACs have until October 19, 2009 to implement these changes in their systems. PET facilities will likely have similar transition time. Continue to submit your claims in accordance with past instructions until your local contractor issues local instructions and implementation date.

For more information:

Related Content

Artificial Intelligence Predicts Alzheimer's Years Before Diagnosis
News | Neuro Imaging | November 14, 2018
Artificial intelligence (AI) technology improves the ability of brain imaging to predict Alzheimer’s disease, according...
Researchers Awarded 2018 Canon Medical Systems USA/RSNA Research Grants
News | Radiology Imaging | November 13, 2018
The Radiological Society of North America (RSNA) Research & Education (R&E) Foundation recently announced the...
Subtle Medical Showcases Artificial Intelligence for PET, MRI Scans at RSNA 2018
News | Artificial Intelligence | November 13, 2018
At the 2018 Radiological Society of North America annual meeting (RSNA 2018), Nov. 25-30 in Chicago, Subtle Medical...
Feature | PET Imaging | November 07, 2018 | By Greg Freiherr
Positron emission tomography (PET) is getting ready to venture outside oncology, cardiology and mainstream neurology....
Podcast | PET Imaging | November 07, 2018
PET is getting ready to venture outside oncology, cardiology and mainstream neurology.
PET Imaging Offers New Possibilities in Chronic Liver Disease Management

Hepatic 18F-FDG, 18F-FAC, and 18F-DFA accumulation are affected in a mouse model of autoimmune hepatitis. (A) Histochemical and immunohistochemical analyses of liver sections from vehicle- and ConA-treated mice. Scale bars represent 50 microns. Transverse PET/CT images (B) and quantification (C) of vehicle- and ConA-treated mice injected with 18F-FDG, 18F-FAC, and 18FDFA. Livers are outlined in a white dotted line. Quantification represents radiotracer accumulation in the liver normalized to a background organ. Image courtesy of Salas J.R., Chen B.Y., Wong A., et al.

News | PET Imaging | October 24, 2018
While liver biopsies are powerful and reliable, they are also invasive, painful, limited and subject to complications....
Huntsman Cancer Institute Installs First Preclinical nanoScan 3T PET/MRI in U.S.
News | PET-MRI | October 10, 2018
The Center for Quantitative Cancer Imaging at Huntsman Cancer Institute (HCI) at the University of Utah in Salt Lake...
Technology and Radionucleotide Development Will Fuel Mobile Gamma Camera Adoption
News | Nuclear Imaging | September 27, 2018
Advancements in healthcare technology, particularly in the surgery category, have led to an increasing adoption of...
Bruker Introduces New High-Performance Preclinical PET/CT Si78 System
Technology | PET-CT | September 26, 2018
September 26, 2018 — Bruker recently announced the introduction of the new preclinical...
PET Imaging Agent Predicts Brain Tau Pathology, Alzheimer's Diagnosis
News | PET Imaging | September 05, 2018
Eli Lilly and Co. and Avid Radiopharmaceuticals Inc. announced a Phase 3 study of positron emission tomography (PET)...