Medicare Compliance & Reimbursement

Getting paid for PET scans about to get easier.

Providers are cheering the Centers for Medicare and Medicaid Services' decision to phase out dozens of HCPCS codes for positron emission tomography (PET) scans and replace them with just 11 CPT Codes. These new codes are 78811-78816;  78459; 78491-78492 and 78608-78609.

The move is good news for a couple of reasons, says Jeff Fulkerson, senior certified coder in the radiology department of Emory Health Care in Stockbridge, GA.  

First of all, the CPT codes are based on the body area the physician scanned. Also, any time you get away from G codes, that's a positive step, Fulkerson insists. Carriers consider G codes experimental and may not cover them at all in some cases. LCD issue: Fulkerson expects the carriers to issue new policies that track their old policies as closely as possible.

Effective date: Providers were confused because CMS Transmittal 475, which announced the change, said the G codes would become invalid retroactive to Jan. 30, 2005. But the new codes won't take effect until April 4, 2005. Now, CMS has clarified that the G codes will remain in effect until April 4, but the change will indeed be retroactive to Jan. 30, according to a release from the Society for Nuclear Medicine. 

Transmittal 475 addresses the payment for professional services for the CPT codes, but not the technical component. SNM expects CMS to issue a Medlearn Matters article soon providing more details on the code switch.