PET NaF-18 Now Covered Under Clinical Study
The Centers for Medicare & Medicaid Services (CMS) recently revised National Coverage Determination (NCD) 220.6 – Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer.
Effective Feb. 26, CMS will cover NaF-18 positron emission tomography (PET) imaging when the Medicare beneficiary’s treating physician determines that it is needed to inform the initial antitumor treatment strategy or to guide subsequent antitumor treatment strategy after the completion of initial treatment, and when the beneficiary is enrolled in, and the NaF-18 PET provider is participating in, a clinical study.
Claims should contain ALL of the following information:
- PI Initial Treatment Strategy or PS Subsequent Treatment Strategy modifier
- PET or PET/CT CPT® code (78608, 78811-78816)
- ICD-9-CM cancer diagnosis code
- HCPCS Level II A9580 Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries
- Q0 modifier Investigational clinical service provided in a clinical research study that is in an approved clinical research study.
Institutional claims should continue to report ICD-9 diagnosis code V70.7 Examination of participant in clinical trial and condition code 30.
Note that, although this coverage decision is effective Feb. 26, it will not be fully implemented until a clinical study is ready to enroll providers and patients. Check the CMS coverage webpage for updates.
Read MLN Matters® No. MM6861, issued March 26, for complete details.