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Radiology Coding Alert

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Try Out Your Trial Coding Skills

Published on Mon Sep 25, 2006

Question: Our facility is participating in a Medicare-approved study. Should I use modifier QV (Item or service provided as routine care in a Medicare qualifying clinical trial) with the code for an FDG PET scan for beneficiaries?


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Answer: No. Instead, you should use modifier QR (Item or service provided in a Medicare specified study), according to CMS Claims Processing Manual CR5124 (www.cms.hhs.gov/Transmittals/downloads/R956CP.pdf).

The rule: For services on or after Jan. 28, 2005, use QR on noninpatient carrier claims for PET scans related to CMS-approved neurodegenerative disease or cancer clinical trials.

The MLN Matters article on the subject is available at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5124.pdf.
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