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Issue Number - Name
0133-PET Scans Paid without Tracer Codes for IDTF (Independent Diagnostic Testing Facility) Providers
Review Type
Automated
Claim Type
Indpendent Diagnostic Testing Facility
Region and State
RAC 1-4
All AB MACs
Date Approved
2019-01-08

Description

All PET Scans require the use of radiopharmaceutical diagnostic imaging agent (tracer).

Affected Codes

PET SCAN CPT Codes-78491, 78492, 78459, 78608, 78811, 78812, 78813, 78814, 78815, 78816 and temporary codes effective 1/1/2018 A9587 and A9598
Tracer Codes – A9515, A9526, A9552, A9555, A9580, A9586, A9587, and A9588

Applicable Policy References

Social Security Act: Section 1833(e)
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, Section 60.3.1 
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, Section 60.3.2 
CMS Manual System, Change Request 10319, effective 11-09-17