New PET/CT Codes
The American Medical Association (AMA) introduced three
new codes for Positron Emission Tomography with
Computed Tomography (PET/CT) in the 2005 Current
Procedural Terminology (CPT): 78814, 78815, and 78816. In
the 2005 Hospital Outpatient Prospective Payment System
(HOPPS) final rule, however, the Centers for Medicare& Medicaid Services (CMS) stated that it is not recognizing
these codes. CMS believes that the existing codes for billing
a PET scan along with an appropriate CT scan, when provided,
preserves the scope of coverage intent of the PET Gcodes
and allows for the continued tracking of the use of
PET scans for various indications. CMS also states that it
plans to issue billing guidance through program instruction
and provider education articles for hospitals to use when
they provide both PET and CT scans to patients in their outpatient
departments. Commercial carriers may not adopt
CMS’ philosophy on the new PET/CT codes. Providers should
contact commercial carriers to determine their policies on
the new PET/CT codes. For more CMS information on these
codes, visit the CMS
web site.
Deletion of Codes 78990, 79900
CPT codes 78890 and 79900 for provision of diagnostic and
provision of therapeutic radiopharmaceutical agents are deleted
from the 2005 CPT-4. The change was effective December
31, 2004. Providers are advised to submit the appropriate
Healthcare Common Procedural Coding System (HCPCS)
codes and revenue codes to report the use of a radiopharmaceutical
agent. The 2005 HOPPS final rule encourages the use
of two new revenue codes 343 (Diagnostic Radiopharmaceuticals)
and 344 (Therapeutic Radiopharmaceuticals) for
reporting use of radiopharmaceuticals.
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First Quarter 2005
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