FDG-PET Coverage Update

As ADVOCATE previously reported, the National Oncologic PET Registry (NOPR) ended Tuesday, June 11, 2013 and CMS released the following information regarding FDG-PET coverage.

Effective June 12, 2013, CMS will cover 1 initial PET scan and 3 subsequent PET scans for the same cancer.

Any PET scan performed prior to June 12, 2013 will not be counted toward the 4 total covered scans.

Break Away from the Static

ADVOCATE is currently working with payors to determine how they will handle the 5th and subsequent scans.  It is expected that a detailed account from the patient’s medical record will be required to support the medical necessity of additional scans. Once we receive direction from the payors, we will communicate this information to you so that we can work with the referring providers to ensure that the necessary clinical history be available to you at the time of dictation.

It is important to note these guidelines apply to FDG-PET only.  Data collection for NaF18 PET scans is still active.

ADVOCATE will continue to provide information on this topic and others impacting radiology as they arise.

Best regards,
Debby Crow, CPC, RCC, ROCC
Coding Documentation & Education Manager