Palmetto GBA
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Ohio Part B Carrier
Positron Emission Tomography (PET) or PET/Computed Tomography (CT)

The  Centers for Medicare & Medicaid Services (CMS) provided Palmetto GBA with two new modifiers for Positron Emission Tomography (PET) claim submissions. The use of one of these modifiers is necessary, along with other current applicable PET modifiers to allow claims to be processed correctly.

Effective for claims processed on and after October 30, 2009, for dates of service (DOS) on or after April 3, 2009, one the following two new HCPCS modifiers must be submitted with claims for PET scans:

  • 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
  • PS: Positron Emission Tomography (PET) or PET/Computed Tomography (CT) to inform 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

These modifiers are applicable with the following FDG PET CPT codes:

  • 78608
  • 78811-78816

Resources

 

 

last updated on 11/16/2009
CMS