Program_Memos / 2002 / AB-02-065

Why This Topic Matters

The memorandum affects how PET services are covered, reported, and processed under Medicare for specified conditions, making it relevant for reimbursement, compliance, and claim submission workflows.

Article Sections

1. Introduction

   Overview of the memorandum purpose, revision timeframe, and the general scope of PET coverage updates.

2. General Description

   Background on positron emission tomography and the type of diagnostic imaging it provides.

3. Coverage of FDG PET for Breast Cancer

   Coverage context for breast cancer-related PET services, including timing, general coverage categories, and limitations.

4. Coverage for Myocardial Viability

   Coverage context for myocardial viability PET services, including timing, general coverage categories, and limitations.

5. General Conditions of Coverage by Allowable Type of FDG PET Scanner

   Summary table of scanner types and coverage timing for the clinical conditions addressed in the memorandum.

6. HCPCS Codes for Breast Cancer PET Scans Performed on or after October 1, 2002

   Code listing and accompanying short descriptions for breast cancer PET services referenced in the memorandum.

7. HCPCS Codes for Myocardial Viability PET Scans performed on or after October 1, 2002

   Code listing and accompanying short descriptions for myocardial viability PET services referenced in the memorandum.

8. Carrier and Fiscal Intermediary Claims Processing Requirements

   Operational guidance for contractors on claims processing edits and system updates related to the policy change.

9. Fiscal Intermediary Billing Requirements

   Billing and submission requirements for institutional claims associated with the PET services discussed in the memorandum.

10. For Carriers Only

    Administrative note regarding pricing information for the relevant HCPCS codes.

11. Provider Bulletin

    Instructions for communicating the policy update to providers and posting the information publicly.