Medicare_Claims_Processing_Manual / transmittal_223

Why This Topic Matters

The transmittal consolidates Medicare instructions that affect how PET scan services are reported and processed under different coverage scenarios. It helps billing and coding professionals understand which topics were updated in the manual and where to look for Medicare coverage details and claim-processing requirements.

Article Sections

1. Summary of Changes

   Overview of the manual update and the broad subject areas affected by the transmittal.

2. Changes in Manual Instructions

   List of chapter and section updates included in the revised manual material.

3. Chapter 13 Table of Contents

   Revised table of contents for the PET scan portion of the Medicare Claims Processing Manual.

4. Positron Emission Tomography (PET) Scans - General Information

   General background on PET imaging and the scope of the Medicare coverage discussion, including definitions and limitations.

5. Billing Instructions

   Billing and payment guidance for carriers, fiscal intermediaries, and institutional providers, including documentation and processing considerations.

6. Use of Gamma Cameras and Full Ring and Partial Ring PET Scanners for PET Scans

   Discussion of scanner types and the related Medicare reporting framework for PET services.

7. PET Scan Qualifying Conditions and HCPCS Code Chart

   Reference section intended to summarize covered PET conditions and associated HCPCS reporting information.

8. PET Scans for Imaging of the Perfusion of the Heart Using Rubidium 82 (Rb 82)

   Coverage topic addressing cardiac perfusion PET imaging using a specific tracer and related service conditions.

9. Expanded Coverage of PET Scans for Solitary Pulmonary Nodules (SPNs)

   Coverage topic focused on PET use for solitary pulmonary nodule evaluation.

10. Expanded Coverage of PET Scans Effective for Services on or After July 1, 1999

    Coverage expansion effective for a specified date range, addressing several cancer-related PET indications.

11. Expanded Coverage of PET Scans Effective for Services on or After July 1, 2001

    Coverage expansion and related documentation expectations for PET services effective in mid-2001.

12. Expanded Coverage of PET Scans for Breast Cancer Effective for Dates of Service on or After October 1, 2002

    Coverage topic describing breast cancer PET use and the associated billing framework for the later effective date.

13. Coverage of PET Scans for Myocardial Viability

    Coverage topic addressing myocardial viability studies, service timing, and related scanner coverage details.

14. Coverage of PET Scans for Thyroid Cancer

    Coverage topic for thyroid cancer PET imaging and the related reporting guidance for later service dates.

15. Coverage of PET Scans for Perfusion of the Heart Using Ammonia N-13

    Coverage topic for cardiac perfusion PET imaging using a different tracer and the associated reporting timeframe.