On July 17, 2009, the Centers for Medicare and Medicaid Services (CMS) posted the long awaited guidance to Medicare Administrative Contractors (MACs) and billing instructions for the April 2009 changes to the FDG PET National Coverage Determination (NCD). Providers will have three new modifiers (in addition to the list of current modifiers) to consider when submitting claims with a date of service (DOS) on or after April 6, 2009 for CPT® codes 78811-78816. After the implementation dates of August 17, 2009, or October 5, 2009, based on the site of service, providers submitting claims with a DOS on or after April 6, 2009 for CPT codes 78811-78816 are now required to identify the procedure as either for initial treatment strategy or subsequent treatment strategy by appending the modifiers PI or PS, respectively.
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Details can be found in the CMS posted transmittals at:
CMS Publishes April Final PET NCD for Solid Tumors and Myeloma and Additional Manual Updates
CMS Publishes Medicare Claims Processing Instructions for PET NCD For Solid Tumors and Myeloma and Additional Manual Updates
