Local Coverage Determination for PET Using New, Proprietary

60.19 – Local Coverage Determination for PET Using New, Proprietary Radiopharmaceuticals for their FDA-Approved Labeled Indications for Oncologic Imaging Only (Rev. 3650, Issued: 11-10-16, Effective: 02-10-17, Implementation: 02-10-17) Effective for dates of service on or after March 7, 2013, local Medicare Administrative Contractors (MACs) may determine coverage within their respective jurisdictions for positron emission tomography (PET) using radiopharmaceuticals for their Food and Drug Administration (FDA) approved labeled indications for oncologic imaging. When the local MAC determines that a claim is noncovered, the claim is denied: The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario Three. Group Code: PR (if claim is received with a GA modifier) otherwise CO CARC: 167 RARC: N/A MSN: 15.4