Positron Emission Tomography Scan Benefit Update

Effective for dates of service on or after December 1, 2004, reimbursement guidelines for Positron Emission Tomography (PET) scans when billed with CPT-4 code 78810 (tumor imaging, positron emission tomography [PET], metabolic evaluation) will be expanded to include the restaging of recurrence of residual thyroid cancers of follicular cell origin that have been previously treated by thyroidectomy and radioiodine ablation for recipients with a serum thyroglobulin level greater than 10 mg/ml and a negative 1-131 whole body scan.

Reminder: Reimbursement for CPT-4 code 78810 requires a Treatment Authorization Request (TAR) for medical documentation or the claim will be denied.