Condition
|
Description
|
Code |
| HCPCS Codes
for FDG PET Scans Performed with Dedicated PET Scanners |
| Alzheimer's Disease |
PET imaging, brain imaging for the differential
diagnosis of Alzheimer’s disease with aberrant
features vs. fronto-temporal dementia
|
G0336 |
Breast Cancer
|
PET imaging, for initial
diagnosis and/or surgical planning, not covered by Medicare
|
G0252 |
| |
PET imaging, staging/restaging after
or prior to course of treatment
|
G0253 |
|
PET imaging, evaluation of response
to treatment, performed during course of treatment
|
G0254 |
Colorectal Cancer
|
PET imaging whole body; diagnosis
|
G0213 |
| |
PET imaging whole body; initial
staging
|
G0214 |
| |
PET imaging whole body; restaging
|
G0215 |
Esophageal Cancer
|
PET imaging whole body; diagnosis
|
G0226 |
| |
PET imaging whole body; initial
staging
|
G0227 |
| |
PET imaging whole body; restaging
|
G0228 |
Head and Neck Cancer
|
PET imaging whole body or regional; diagnosis;
excluding thyroid and CNS cancers
|
G0223
|
| |
PET imaging whole body or regional; initial
staging; excluding thyroid and CNS cancers
|
G0224 |
| |
PET imaging whole body or regional; restaging;
excluding thyroid and CNS cancers
|
G0225 |
Lung Cancer (non-small cell)
|
PET imaging whole body; diagnosis
|
G0210 |
| |
PET imaging whole body; initial
staging
|
G0211 |
| |
PET imaging whole body; restaging
|
G0212 |
Lymphoma
|
PET imaging whole body; diagnosis
|
G0220 |
| |
PET imaging whole body; initial
staging
|
G0221 |
| |
PET imaging whole body; restaging
|
G0222 |
Melanoma
|
PET imaging whole body; diagnosis
|
G0216 |
| |
PET imaging whole body; initial
staging
|
G0217 |
| |
PET imaging whole body; restaging
|
G0218 |
| |
PET imaging whole body; for non
covered indications
|
G0219 |
Myocardial Viability
|
PET imaging; metabolic assessment for myocardial viability
following inconclusive SPECT study
|
G0230 |
| Myocardial Viability |
PET imaging; metabolic evaluation for the determination
of myocardial viability as a primary or initial diagnostic study prior
to revascularization |
78459 |
Refractory seizures
|
PET imaging; metabolic brain imaging for pre-surgical evaluation
of refractory seizures
|
G0229 |
Single Pulmonary Nodule
|
PET imaging regional or whole body; characterization
|
G0125 |
Thyroid Cancer
|
PET imaging, for restaging of
previously treated thyroid cancer of follicular cell origin following
negative I-131 whole body scan
|
G0296 |
| |
|
|
| HCPCS Codes for FDG
PET Scans Performed with Gamma Cameras |
Colorectal Cancer
|
PET, whole body, for recurrence of
colorectal or colorectal metastatic cancer
|
G0231 |
Lymphoma
|
PET, whole body, for staging
and characterization of lymphoma
|
G0232 |
Melanoma
|
PET, whole body, for recurrence of
melanoma or melanoma metastatic cancer
|
G0233 |
| Single Pulmonary Nodule or Lung Cancer (non-small cell) |
PET, regional or whole body, for solitary
pulmonary nodule following Ct, or for initial
staging of non-small cell lung cancer |
G0234 |
| |
|
|
| HCPCS Code for FDG |
N/A
|
FDG per dose (4-40mCi/ml)
|
C1775 |
| |
|
|
| HCPCS
Codes for PET Myocardial Perfusion Imaging with Rubidium 82 or Ammonia
N-13 |
Myocardial Perfusion
|
PET myocardial perfusion imaging, (following previous
PET, G0030-G0047);single study, rest or stress (exercise and/or pharmacologic).
|
G0030
|
| |
PET myocardial perfusion imaging, (following previous
PET, G0030-G0047);multiple studies, rest or stress (exercise and/or pharmacologic).
|
G0031
|
| |
PET myocardial perfusion imaging, (following rest SPECT,
78464);single study, rest or stress (exercise and/or pharmacologic).
|
G0032
|
| |
PET myocardial perfusion imaging, (following rest SPECT,
78464);multiple studies, rest or stress (exercise and/or pharmacologic).
|
G0033
|
| |
PET myocardial perfusion imaging, (following stress SPECT,
78465);single study, rest or stress (exercise and/or pharmacologic).
|
G0034
|
| |
PET myocardial perfusion imaging, (following stress SPECT,
78465);multiple studies, rest or stress (exercise and/or pharmacologic).
|
G0035
|
| |
PET myocardial perfusion imaging, (following coronary
angiography, 93510-93529); single study, rest or stress (exercise and/or
pharmacologic).
|
G0036
|
| |
PET myocardial perfusion imaging, (following coronary
angiography, 93510-93529); multiple studies, rest or stress (exercise
and/or pharmacologic).
|
G0037
|
| |
PET myocardial perfusion imaging, (following stress planar
myocardial perfusion, 78460); single study, rest or stress (exercise
and/or pharmacologic).
|
G0038
|
| |
PET myocardial perfusion imaging, (following stress planar
myocardial perfusion, 78460); multiple studies, rest or stress (exercise
and/or pharmacologic).
|
G0039
|
| |
PET myocardial perfusion imaging, (following stress echocardiogram,
93350); single study, rest or stress (exercise and/or pharmacologic).
|
G0040
|
| |
PET myocardial perfusion imaging, (following stress echocardiogram,
93350); multiple studies, rest or stress (exercise and/or pharmacologic).
|
G0041
|
| |
PET myocardial perfusion imaging, (following stress nuclear
ventriculogram, 78481 or 78483); single study, rest or stress (exercise
and/or pharmacologic).
|
G0042
|
| |
PET myocardial perfusion imaging, (following stress nuclear
ventriculogram, 78481 or 78483); multiple studies, rest or stress (exercise
and/or pharmacologic).
|
G0043
|
| |
PET myocardial perfusion imaging, (following rest ECG,
93000); single study, rest or stress (exercise and/or pharmacologic).
|
G0044
|
| |
PET myocardial perfusion imaging, (following rest ECG,
93000); multiple studies, rest or stress (exercise and/or pharmacologic).
|
G0045
|
| |
PET myocardial perfusion imaging, (following stress ECG,
93015); single study, rest or stress (exercise and/or pharmacologic).
|
G0046
|
| |
PET myocardial perfusion imaging, (following stress ECG,
93015); multiple studies, rest or stress (exercise and/or pharmacologic). |
G0047 |
| |
|
|
| Radiopharmaceuticals
for PET Myocardial Perfusion Imaging |
|
Rubidium RB-82, per dose |
Q3000 |
| New Code effective Jan. 1, 2004 |
Ammonia N-13, per dose |
A9526 |
| |
|
|
