New Positron Emission Tomography (PET) Radiopharmaceutical/Tracer Unclassified Codes

Positron Emission Tomography (PET) is a nuclear medicine imaging study used to detect normal and abnormal tissues. All PET scan services are billed using PET or PET/ Computed Tomography (CT) CPT codes 78459, 78491, 78492, 78608, and 78811 through 78816. Each of these CPT codes always requires the use of a radiopharmaceutical code, also known as a tracer code. Therefore, an applicable tracer code, along with an applicable CPT code, is necessary for claims processing of any PET scan services. 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, 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. Effective January 1, 2017, with the January 2017 quarterly HCPCS update, the two temporary PET HCPCS codes are: • A9597 – Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified and • A9598 – Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified.

Source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10319.pdf