Wiki Pet/ct 78608 modifier

[cjacobs]

I was told that it was not require to use a modifier (PI or PS) when billing a PET brain 78608 when patient has medicare. If you are in agreement please send me some documention. Thanks.

 

[donnajrichmond]

If you are performing a brain PET for oncology reasons you need to use PI/PS. If the brain PET is for dementia/Alzheimer's you do not. See CMS Claims Processing Manual, Chapter 13

 

[cjacobs]

I have already look there and that information that you stated is not there or I am not seeing it. Can you please copy and paste the statement or link?

 

[jgf-CPC]

Here you go:
http://www.snm.org/index.cfm?PageID=8889&RPID=18

 

[donnajrichmond]

I have already look there and that information that you stated is not there or I am not seeing it. Can you please copy and paste the statement or link?

Claims Processing Manual, Chapter 13, Section 60.16
C. Billing Changes for A/B MACs, FIs and Carriers
Effective for claims with dates of service on or after April 3, 2009, contractors shall accept FDG PET claims billed to inform initial treatment strategy with the following CPT codes AND modifier –PI: 78608, 78811, 78812, 78813, 78814, 78815, 78816.
Effective for claims with dates of service on or after April 3, 2009, contractors shall accept FDG PET claims with modifier –PS for the subsequent treatment strategy for solid tumors using a CPT code above AND an ICD-9 cancer diagnosis code.
http://www.cms.gov/manuals/downloads/clm104c13.pdf