CMS tweaks coverage of PET scans for determining treatment strategy

Why This Topic Matters

Medicare coverage and billing edits for PET imaging can affect claim acceptance, denial risk, and documentation workflow for oncology practices. Understanding the scope of the CMS update helps billing teams align claims with current Medicare processing requirements and avoid avoidable processing errors.

Article Sections

1. Coverage changes and effective dates

   Overview of the Medicare policy update, including the timing of the changes and the general categories of PET coverage being revised.

2. No longer covered

   Summary of broad PET uses that are being removed from coverage under the updated CMS policy.

3. New coverage

   Summary of the broader categories of PET services that are being added to coverage under the updated CMS policy.

4. ICD-9, modifier changes

   Discussion of the billing-related changes CMS issued for claims processing, including diagnosis-code handling and the addition of new modifiers.