CMS Releases Coding & Coverage Instructions for PET Services April 1, 2005Effective Dates Retroactive to January 28th, PET Claims Paid No Later than April 18th

April 25, 2005

CMS Releases Coding & Coverage Instructions for PET Services April 1, 2005Effective Dates Retroactive to January 28th, PET Claims Paid No Later than April 18th

The Centers for Medicare and Medicaid Services (CMS) released change request 3741 on April 1, 2005 detailing coding changes and long awaited expanded coverage clarifications for PET imaging services. During emergency meetings within various departments, CMS officials decided to uphold the decision to discontinue the use of many of the G PET codes and implement the American Medical Association (AMA), Current Procedural Terminology (CPT) PET codes for all covered PET imaging procedures.

The Society of Nuclear Medicine (SNM) and other professional societies have been advocating for this change from the complicated numerous G Healthcare Common Procedural Coding System (HCPCS) Level II codes to the AMA CPT codes (see original and follow up story in the Related Items box below). The SNM has obtained two CMS Transmittals 31 and 518 released on April 1, 2005 in the related items below, in summary these transmittals state;

  • The Effective Date for ALL Coding and Coverage Changes are Retroactive to Date of Service (DOS) January 28th, Providers May Resubmit Claims to Medicare Contractors
  • The Implementation Date for All Coding and Coverage Changes for PET Claims Paid by Medicare Contractors, is No Later than April 18th, 2005. Contractors Shall HOLD PET claims received April 1, 2005, and later, to the April 18th date.
  • The January 28th Effective Date Supersedes any Previous CMS Change Request Publications
  • Providers Should use the PET Tumor CPT codes for the Newly Covered Indications for Cervical Cancer (Staging for invasive cervical cancer as an adjunct to conventional imaging)
  • Effective Immediately Providers Should Update their Charge Masters Replacing All Covered Indications of PET Services formerly Coded with G HCPCS codes with the Appropriate CPT code
  • Non Covered PET Services will continue to be Coded using G HCPCS codes, e.g. G0219, G0252 & New HCPCS code G0235 (This code is for a non-covered PET service. Providers are to issue an Advanced Beneficiary Notice (ABN) for any non-covered PET services.)
  • For Hospitals Only; Claims with DOS January 28th or 29th; any Claims coded with CPT codes will initially be rejected; these rejected claims will be adjusted in July by the fiscal intermediaries.

Also in the Related Items box below you will find the "SNM PET to HCPCS Level II Crosswalk," a summary of the deactivated and New G-codes linked to the PET CPT codes to assist SNM members. Additionally, CMS plans to release provider education related to the instructions at www.cms.hhs.gov/medlearn/matters.

PET: CPT to HCPCS Level II Crosswalk (Updated 04/1/2005)