National Coverage: New Positron Emission Tomography Code for Alzheimer Disease

National coverage of PET also includes patients with suspected AD who enroll in a large, CMS-approved, practical clinical trial. Access a copy of the CMS coverage decision at http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=104

As of October 4, 2004, Healthcare Common Procedure Coding System (HCPCS) code G0336 can be used to report this PET service. This code also may be reported retroactively for the period January 1, 2004 through October 3, 2004. According to the 2004 Medicare Physician Fees Schedule update (http://www.cms.hhs.gov/manuals/pm_trans/R306CP.pdf), code G0336 is carrier priced. For specific billing and reimbursement instructions, please contact your local Medicare carrier.

The ACR previously submitted comments regarding this coverage decision and commended CMS for encouraging further studies of PET in a broader population of patients who develop symptoms of dementia. The ACR is pleased that CMS is continuing to work with the National Institute of Aging, Agency for Healthcare Research and Quality, Alzheimer’s Association, device manufacturers, and experts in the AD and imaging to develop a large practical clinical trial regarding early dementias and AD. Click here for a copy of the ACR comments to CMS.