December 18, 2017

CMS Allows the Use of Positron Emission Tomography (PET) Radiopharmaceutical/Tracer Codes

Effective on date of service January 1, 2018, the Centers for Medicare and Medicaid Services will allow the use of two temporary PET radiopharmaceutical unclassified tracer codes for claims requiring the use of a dedicated PET radiopharmaceutical/tracer for which no CPT or HCPCS code currently exists. These codes can be reported with the applicable PET or PET/CT scan service(s) provided as determined by CMS.

A9597 (Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified),

A9598 (Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified

These additional HCPCS codes were created by CMS in 2017 to alleviate inordinate spans of time between when a coverage determination is made and when it can be fully implemented via valid claims processing. These codes are meant to be used temporarily pending the creation, approval and implementation of permanent CPT codes that would later specifically define their function.

For more information regarding claims reporting criteria for use of these two codes, please see MLN Matters Article MM10319.