HCFA continues to expand policies regulating Medicare reimbursement for positron emission tomography (PET) scans. Dramatic changes are effective July 1, 2001, according to Pam Kassing, director of economics and health policy for the American College of Radiology, presenting an update at the Radiology Business Managers Association (RBMA) spring educational meeting June 3-6 in Scottsdale, Ariz.
The welcome changes expand coverage for the traditionally restricted PET studies, Kassing says, and introduce new G codes to report services provided to Medicare patients. In addition, they eliminate the distinct alpha modifiers previously required on PET codes and remove onerous documentation that was required to accompany claims.
The modifications affect coding and billing for patients with Medicare coverage only. The CPT Codes used to report PET imaging studies to other insurers remain unchanged.
Note: An explanation of the CPT codes may be found in the March 2001 issue of
Radiology Coding Alert . To view this article for free this month, visit our Web site
www.codinginstitute.com, and click on "HCFA Plans to Expand Coverage Areas -- Attention to Detail Increases Timely PET Imaging Pay Up." New Conditions Included in PET Coverage HCFA's recent announcement, published in Program Memorandum AB-01-54, had been anticipated since last December. At that time, the agency indicated it was prepared to expand coverage according to science-based data proving the effectiveness of PET for the initial diagnosis, staging and restaging of certain cancers.
Prior to July 1, Medicare coverage included one non-cancer-related use of PET (imaging of the perfusion of the heart) and restricted uses involving four cancers (initial staging of lung cancer, recurrence of colorectal cancer, staging and characterization of lymphoma, and recurrence of melanoma). With implementation of its new rules, the list of covered services is now expanded to include head and neck cancers, esophageal cancer and evaluation of refractory epileptic seizures.
The HCFA Program Memorandum also explicitly outlines several uses for related conditions that are excluded: thyroid cancer, cancer of the central nervous system including the brain, and evaluation of regional nodes in melanoma patients. New Codes Describe Diagnosis, Initial Staging and Restaging Studies AB-01-54 presents a comprehensive list of the G codes radiology coders are required to use when reporting PET studies. In the past, Medicare provided only one code to describe PET scanning for each distinct disease or cancer site. Now, three codes define services for each cancer one for diagnosis, one for initial staging and one for restaging.
Besides announcing the new codes, HCFA advised carriers about the discontinuation of G0126, G0163, G0164 and G0165, as of June 30. Also, the definition of G0125 was altered and now reads, "PET imaging, regional or whole body; single pulmonary [...]
