Reader Question: PET Scans

Question: HCFA has assigned G0125 (PET lung imaging of solitary pulmonary nodules) and G0126 (... initial staging of pathologically diagnosed non-small cell lung cancer) for positron emission tomography (PET) scans. Are there any diagnosis criteria for performing this scan? Have there been any special billing requirements published?

Illinois Subscriber

Answer: Some local medical review policies (LMRPs) relate to PET scans and vary by fiscal intermediary (FI). Look for your FI on www.lmrp.net then download the LMRPs that relate to your area to see which relate to PET scans. You will need unzipping software because the LMRPs are zipped for faster download. PET scans for oncology are still under HCFA test code. Each code given in the HCPCS publications carries a very specific diagnosis. If the patient bill does not list the diagnosis, HCFA will not pay.

- Published on 2001-04-01