The U.S. Centers for Medicare and Medicaid Services (CMS) released two transmittals (31 and 508) on April 1 that update the PET national coverage determination (NCD) for the new cervical cancer coverage guidelines, describe the agency's PET registry project, and explain the coding and billing instructions for the new current procedural terminology (CPT) codes.
The NCD for the use of FDG-PET in staging cervical cancer is for patients with newly diagnosed and locally advanced cervical cancer with no extrapelvic metastasis on conventional imaging tests, such as CT or MRI. Under CMS guidelines, the following conditions must be met:
- A pathologic diagnosis of cervical cancer must have already been made before the FDG-PET scan is performed.
- The results of other imaging procedures used (e.g., CT or MRI) must be reported.
- The available conventional imaging tests are negative for extrapelvic metastasis.
The agency said that providers holding claims for cervical cancer studies performed after the effective date of January 28 this year should file their claims using the appropriate CPT code
CMS is referring to the PET registry project as "coverage with evidence development." All registry projects, including PET, are on hold at CMS until the details can be worked out, the agency said. CMS estimates that it will take 3-4 months for the issues to be resolved with other agencies.
The agency said it will provide notification to providers and beneficiaries where services identified as "coverage with evidence development" as can be accessed via a Federal Register notice or on the CMS coverage Web site when they are available.
The CMS also said that it will be ready to start processing claims under the January 28, 2005, PET CPT codes by April 18. It has requested that Medicare contractors hold claims received April 1, and later, and begin to process claims no later than April 18 this year, which is the implementation date for all coding changes.
In addition, CMS said that the two noncovered Healthcare Common Procedure Coding System (HCPCS) G-codes -- G0219 noncovered melanoma and G0252 noncovered breast cancer -- should be used to bill for these specific indications. A new HCPCS G-code -- "G0235 PET imaging, any site not otherwise specified" -- will be used to bill for all other noncovered indications, CMS said.
By AuntMinnie.com staff writers
April 8, 2005
Related Reading
PET registry previewed at AMI meeting, March 21, 2005
CMS adds PTA with stenting coverage, March 18, 2005
CMS activates CPT codes for PET, February 22, 2005
Medicare expands PET coverage for cervical cancer, January 31, 2005
Medicare to expand carotid artery stenting coverage, December 20, 2004
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