Health Information Management

Q/A: Limits on PET scans

APCs Insider, August 13, 2009

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Q: Is there a limit on how frequently patients may receive PET scans, such as 78815 (Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography [CT] for attenuation correction and anatomical localization; skull base to mid-thigh)? We are billing facility fees for nuclear medicine.

A: CMS published National Coverage Determinations (NCDs) for PET scans. The limitations are not necessarily related to the CPT code for the procedure, but for the medical reason/diagnosis for which the PET is being performed. You can review the complete list of NCDs, including those for PET scans, online.

Consider consulting your FI/MAC for additional LCD information for these exams.



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