HCPCS Modifier PI

Description
Pet tumor init tx strat.

Guidelines/Instructions
This modifier may be submitted with the following CPT codes:

  • All claims for CPT code 78608 and CPT codes 78811 through 78816 must be submitted with either HCPCS modifier PI or HCPCS modifier PS. If these CPT codes are submitted without one of these modifiers, the services will be returned as unprocessable (rejected with remark codes MA130, N519, N517, and CO-4).
  • To submit a claim for the professional component only, submit CPT modifier 26 in the first modifier position and HCPCS modifier PI (or HCPCS modifier PS) in the second modifier position
  • To submit a claim for the technical component only, submit HCPCS modifier TC in the first modifier position and HCPCS modifier PI (or HCPCS modifier PS) in the second modifier position
  • These modifiers only apply to PET scans related to cancer

Reference: CMS MLN Matters article MM6632 (PDF, 97 KB).

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