CMS provides coverage and billing updates for PET scans

New billing instructions for PET scans were recently published by CMS in Transmittals 31 and 527. This information addresses the coverage of Fluoro-D-Glucose (FDG) PET scans by Medicare. Transmittal 514, Attachment A contains a list of deleted HCPCS/ CPT codes for PET scans, information regarding APC assignments, status indicator (SI) modifications, and outpatient code editor (OCE) changes of other PET scan services. Of note is the deletion of G codes that were replaced by CPT codes. The HCPCS G codes deleted are G0030-G0047, G0125, G0210-G0218, G0220-G0234, G0253-G0254, G0253-G0254, G0296 and G0336. The CPT codes replacing the PET Scan HCPCS...

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Note:  The following article synopsis was NOT provided by the AHA. It was created by Find-A-Code/innoviHealth.

Article Overview

This article covers CMS updates related to PET scan coverage and billing under Medicare. It discusses transmittal-based changes affecting PET services, including code set updates, APC and OCE-related changes, and the transition from older HCPCS G codes to CPT-based reporting. The content is useful for coders, billing staff, compliance teams, and imaging practices that need to track Medicare policy changes for PET procedures.

Why This Topic Matters

PET scan billing and coverage updates can affect claim submission, code selection, and outpatient payment processing for imaging providers. Understanding these CMS changes helps organizations keep billing workflows aligned with current Medicare guidance.

What You Will Learn

  • How CMS updates can affect PET scan billing and coverage
  • Which broad PET-related service categories are affected by transmittal updates
  • How PET coding changes relate to Medicare outpatient payment and processing
  • What types of policy changes imaging and billing teams should monitor

Who Should Read This

  • Medical coders
  • Billing specialists
  • Compliance staff
  • Radiology and nuclear medicine practices
  • Outpatient hospital revenue cycle teams

Codes Discussed

  • HCPCS Level II: G0125
  • HCPCS Level II: G0210
  • HCPCS Level II: G0211
  • HCPCS Level II: G0212
  • HCPCS Level II: G0213
  • HCPCS Level II: G0214
  • HCPCS Level II: G0215
  • HCPCS Level II: G0216
  • HCPCS Level II: G0217
  • HCPCS Level II: G0218
  • HCPCS Level II: G0220
  • HCPCS Level II: G0221
  • HCPCS Level II: G0222
  • HCPCS Level II: G0223
  • HCPCS Level II: G0224
  • HCPCS Level II: G0225
  • HCPCS Level II: G0226
  • HCPCS Level II: G0227
  • HCPCS Level II: G0228
  • HCPCS Level II: G0229
  • HCPCS Level II: G0230
  • HCPCS Level II: G0231
  • HCPCS Level II: G0232
  • HCPCS Level II: G0233
  • HCPCS Level II: G0234
  • HCPCS Level II: G0253
  • HCPCS Level II: G0254
  • HCPCS Level II: G0296
  • HCPCS Level II: G0336
  • CPT: 78459
  • CPT: 78491
  • CPT: 78492
  • CPT: 78608
  • CPT: 78609
  • CPT: 78811
  • CPT: 78812
  • CPT: 78813
  • CPT: 78814
  • CPT: 78815
  • CPT: 78816

Code Ranges Discussed

  • HCPCS Level II: G0030-G0047
  • HCPCS Level II: G0210-G0218
  • HCPCS Level II: G0220-G0234
  • HCPCS Level II: G0253-G0254

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