Jimmie Hebert
CMC, CMIS, CMOM

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January 5, 2009

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PET Scan Coverage is Expanding

Codes recognized by Medicare are:

G0296 (new code): “PET imaging, full and partial ring PET scanner only, for restaging of previously treated thyroid cancer of follicular cell origin following negative I-131 whole body scan.” This one is covered for recurrent or residual thyroid cancer can’t be localized using the Iodine-131 whole body scan.

Q4078 (new code): “Supply of radiopharmaceutical diagnostic imaging agent, Ammonia N-13, per dose.” This one is used for the Ammonia N-13 when it is used as a tracer for PET scan for perfusion of the heart.

CMS already covers PET scans for diagnosing and for determining the status of the previously diagnosed patients with colorectal cancer, non small cell lung cancer, esophageal, lymphoma, melanoma, and head and neck cancer. Medicare also covers scans for solitary pulmonary nodules and refractory seizures.

CMS is considering PET coverage for other diagnosis such as detecting brain tumors, pancreatic cancer, cervical cancer, ovarian cancer, testicular cancer, and small cell lung cancer.

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