Medicare_Claims_Processing_Manual / CMS 100-04 Change Request 5665

Why This Topic Matters

The update clarifies which PET scan-related identifiers are addressed in the manual and how CMS revised the associated claims processing instructions over time. It matters for organizations that bill or adjudicate PET scan services under Medicare and need to align internal references with CMS manual changes.

Article Sections

1. Summary of Changes

   Overview of the CMS change request and the types of PET scan coding information revised in the manual.

2. Changes in Manual Instructions

   Lists the chapters and subsections affected by the manual update and identifies which portions were revised or added.

3. Background

   Provides general context for PET scan billing, tracer use, and the manual material being corrected.

4. Policy

   States the purpose of the change request and its relationship to prior CMS instructions.

5. Provider Education Table

   Describes provider education availability and contractor communication expectations tied to the change request.

6. Contacts

   Lists CMS contact information for pre- and post-implementation questions.

7. Chapter 13 - Radiology Services and Other Diagnostic Procedures

   Contains the updated manual sections for PET scan coding, tracer reporting, and beneficiary notice language.

8. 60.3.1 - Appropriate CPT Codes Effective for PET Scans for Services Performed on or After January 28, 2005

   Presents the PET scan procedure code references addressed by the manual revision and the associated effective date framing.

9. 60.3.2 - Tracer Codes Required for PET Scans

   Describes tracer code applicability for PET scan billing across institutional and professional settings, including effective-date distinctions.

10. 60.3.3 - Medicare Summary Notice (MSN)

    Gives the beneficiary notice message used when a PET-related claim is denied as noncovered.

11. 60.3.4 - Remittance Advice Message

    Identifies the remittance advice remark language associated with a national coverage-based denial.