Medicare Proposes Coverage Expansion of PET

Medicare Proposes Coverage Expansion of PET The Centers for Medicare and Medicaid Services (CMS) issued a national coverage determination (NCD) on April 3, 2009 to expand coverage for initial diagnostic testing with positron emission tomography (PET) for many Medicare beneficiaries who are being treated for cancer. A minimally invasive diagnostic imaging procedure, PET uses a radioactive tracer to evaluate glucose metabolism in tumors and in normal tissue. The test may provide important clinical information to guide the initial treatment approach for many types of tumors. This additional information may help physicians to distinguish benign from cancerous lesions and to...

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

Article Overview

This article summarizes a CMS national coverage determination affecting Medicare coverage for positron emission tomography (PET) in oncology. It is relevant to coders, billing staff, and imaging practices that need to understand the scope of the coverage change, the affected cancer categories, and the mention of interim billing guidance and registry-related requirements. The article also points readers to CMS resources for additional claims and billing instructions.

Why This Topic Matters

Coverage changes for advanced imaging can affect reimbursement, claim submission, and documentation workflows for oncology services. This piece highlights a Medicare policy update and related billing references that may influence how PET services are reported and processed.

What You Will Learn

  • The scope of a Medicare coverage expansion for PET in oncology
  • Which broad cancer categories are discussed in relation to PET coverage
  • How the article frames CMS billing guidance and registry-related coverage issues
  • Which PET-related billing references are mentioned by the source

Who Should Read This

  • Medical coders
  • Billing staff
  • Radiology practices
  • Oncology practices
  • Compliance staff
  • Revenue cycle teams

Codes Discussed

Modifiers Discussed


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