The U.S. Centers for Medicare and Medicaid Services (CMS) has reissued its guidance and billing instructions for the April 2009 changes to the National Coverage Determination (NCD) on FDG-PET.
Providers will have two new modifiers, in addition to current modifiers, to consider when submitting claims with a date of service on or after April 6, 2009, for CPT codes 78608 and 78811-78816 for oncologic procedures.
On or after October 19, 2009, providers submitting claims with a date of service on or after April 6, 2009, for CPT codes 78608 and 78811-78816 will be required to identify the procedure as either for initial treatment strategy or subsequent treatment strategy by appending the modifiers PI or PS, respectively.
CMS removed the previously identified ICD-9 range of codes allowing discretion at the local level with Medicare contractors. CMS did identify the combination of PI and ICD-9 codes that are newly noncovered 185 for adenocarcinoma of the prostate.
Related Reading
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Senators oppose rad therapy cuts, September 28, 2009
CMS backs coverage of FDG-PET for cervical cancer, August 14, 2009
CMS considers 21.5% physician pay cut in 2010, July 8, 2009
CMS pitches 90% use rate in proposed 2010 MPFS rule, July 1, 2009
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