New Positron Emission Tomography Radiopharmaceutical/Tracer Unclassified Codes

December 2017 ~

CMS issued a notice announcing two new Positron Emission Tomography (PET) radiopharmaceutical unclassified tracer codes to be used temporarily pending the creation/approval/implementation of permanent CPT codes.

Intended to help alleviate inordinate spans of time between when a coverage determination is made and when it can be fully implemented via valid claims processing, the Centers for Medicare & Medicaid Services (CMS) has created two new PET radiopharmaceutical unclassified tracer codes that can be used temporarily pending the creation/approval/implementation of permanent CPT codes that would later specifically define their function.

Once permanent replacement PET tracer codes are implemented via a subsequent CMS CR, that subsequent CR will also discontinue use of the temporary tracer code A9597 or A9598 for that specified indication. The following two PET tracer codes were effective as of January 1st, 2017:

  • 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

Effective for claims with dates of service on or after January 1st, 2018, the following Healthcare Common Procedure Coding System (HCPCS) codes shall be used ONLY AS NECESSARY FOR AN INTERIM PERIOD OF TIME under the circumstances explained above. Specifically, there are two circumstances that would warrant use of the two new codes:

  • After Food and Drug Administration (FDA) approval of a PET oncologic indication –or
  • After CMS approves coverage of a new PET indication –and
  • ONLY if either of those situations requires the use of a dedicated PET radiopharmaceutical/tracer code that is currently non-existent.

Additional information regarding this change can be seen on CMS’ Change Request 10319.

CPT® is a registered trademark of the American Medical Association.

 

Source(s): CMS MLN Matters; Change Request 10319;

 

 

 

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