A: The appropriate CPT® code to report a sodium fluoride-18 (NaF) PET/CT whole body bone scan performed on a PET/CT scanner to identify bone metastasis is 78816, Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body. Additionally, the appropriate Healthcare Common Procedural Coding System (HCPCS) Level II radiopharmaceutical code A9580, Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries, must be reported.
For Medicare reimbursement, under the Centers for Medicare and Medicaid Services (CMS) “coverage with evidence development” through the National Oncologic PET Registry (NOPR) program, the following must be included on the claim:
· Appropriate PET or PET/CT CPT code for the study performed (78811-78816)
· Oncology PET modifier PI (initial treatment strategy) or PS (subsequent treatment
· Modifier Q0 (Q zero) to identify a facility providing an investigational clinical service in a
clinical research study
· Modifier KX with modifier 26 to denote the professional component only. Use of
modifier KX confirms that the requirements specified in the medical policy have been
met and allows the Medicare administrative contractor to differentiate the study as PET
with sodium fluoride-18 (NaF) rather than PET with F-18 fluorodeoxyglucose (FDG).
Modifier KX is not required for hospital claims, billing globally or billing only the
· Appropriate ICD-9 cancer diagnosis code. Hospital Outpatient Prospective Payment
System claims must include diagnosis code V70.7 (examination of participant in
clinical trial) in the second diagnosis position and condition code 30 (qualifying clinical
trials non-research services provided to all patients, including managed care enrollees
enrolled in a qualified clinical trial )
· Radiopharmaceutical HCPCS Level II code A9580
The NOPR program was established in response to CMS’ proposal to expand coverage for PET with F-18 FDG to include cancers and indications not currently eligible for Medicare reimbursement. Under CMS’s “coverage with evidence development”, Medicare reimbursement can be obtained if the patient’s referring physician and provider submit data to a clinical registry managed by the NOPR to assess the impact of FDG-PET imaging on cancer management.
Recently, CMS expanded coverage through the NOPR to include NaF-PET to identify bone metastases and improved health outcomes under “coverage with evidence development.” The NOPR launched a registry for NaF-PET similar to the FDG-PET registry and began accepting patients on January 31, 2011.
The NOPR is sponsored by the Academy of Molecular Imaging (AMI) and managed by the American College of Radiology (ACR) through the American College of Radiology Imaging Network (ACRIN).
For more information on PET reporting and the NOPR, go to