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Issue Number - Name
0010 - Cardiac PET Scans
Review Type
Complex
Claim Type
Outpatient Hospital, Physician/Professional Services
Region and State
RAC 3
JN, First Coast only
Date Approved
2017-02-01

Description

Medical necessity and Coding review- Documentation will be reviewed to determine if Cardiac PET Scans meet Medicare coverage criteria.

Affected Codes

  • HCPCS 78459, 78491, 78492, A9926, A9526, A9555, A9552

Applicable Policy References

  • CMS NCD 220.6.1
  • CMS NCD 220.6.8
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, Section 60
  • Annual American Medical Association, CPT Manual, Coding Guidelines
  • Annual ICD-9-CM and ICD-10-CM Manuals, Coding Guidelines
  • Annual HCPCS Manual, Coding Guidelines