Get paid for PET under registry, but hold those claims for now

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

Article Overview

This piece covers a Medicare policy update related to oncology PET imaging under a national registry program. It is aimed at coders, billing staff, imaging providers, and compliance teams who need to understand the general coverage context, the registry participation framework, and the timing of claims processing changes. The article also references the organizations and resources associated with the registry and the broader shift toward evidence development for covered imaging services.

Why This Topic Matters

It helps imaging and billing professionals recognize that Medicare payment for certain PET-related services is tied to registry participation and that claims timing may be temporarily affected while carriers implement instructions.

Article Sections

  1. Medicare registry-based PET coverage and claims timing

    This section discusses Medicare’s updated framework for oncology PET imaging under a national registry and notes the temporary delay in claims processing. It also places the change in the context of carrier system updates and payment administration.

  2. Registry participation, facility activity, and professional organizations

    This section summarizes early registry participation and comments from facility and medical society representatives. It also identifies organizations involved in supporting the policy change and the registry model.

  3. Nationally covered cancer indications and registry resources

    This section outlines the broader covered oncology context and points readers to registry and Medicare resources for participation and facility information. It emphasizes the difference between registry-based coverage and other nationally covered indications.

What You Will Learn

  • How Medicare is using a registry-based approach for certain oncology PET services
  • Why claims for these services may need to be held temporarily
  • What kinds of providers and facilities are involved in registry participation
  • Where to find registry participation and facility information
  • How the policy fits into broader Medicare coverage for oncology imaging

Who Should Read This

  • Medical coders
  • Radiology billing staff
  • Imaging facility administrators
  • Compliance teams
  • Oncology practice managers
  • Medicare billing specialists

Codes Discussed

Code Ranges Discussed

  • CPT: 78811–78813
  • CPT: 78814–78816

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