Billing and Coverage Changes for PET Scans for Cervical

60.17 – Billing and Coverage Changes for PET Scans for Cervical Cancer Effective for Services on or After November 10, 2009 (Rev. 3650, Issued: 11-10-16, Effective: 02-10-17, Implementation: 02-10-17) A. Billing Changes for A/B MACs (A and B) Effective for claims with dates of service on or after November 10, 2009, contractors shall accept FDG PET oncologic claims billed to inform initial treatment strategy; specifically for staging in beneficiaries who have biopsy-proven cervical cancer when the beneficiary’s treating physician determines the FDG PET study is needed to determine the location and/or extent of the tumor as specified in Pub. 100-03, section 220.6.17. EXCEPTION: CMS continues to non-cover FDG PET for initial diagnosis of cervical cancer related to initial treatment strategy. NOTE: Effective for claims with dates of service on and after November 10, 2009, the – Q0 modifier is no longer necessary for FDG PET for cervical cancer. B. Medicare Summary Notices, Remittance Advice Remark Codes, and Claim Adjustment Reason Codes Additionally, contractors shall return as unprocessable /return to provider for FDG PET for cervical cancer for initial treatment strategy billed without the following: one of the PET/PET/ CT CPT codes listed in 60.16 C above AND modifier PI AND a cervical cancer diagnosis code. The contractor shall use the following remittance advice messages and associated codes when returning claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario Two. Group Code: CO CARC: 4 RARC: MA130 MSN: N/A