skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Join eNews       En Español
Text Size:
YouTube LinkedIn Email Print
Send a link to this page
[Multiple email addresses must be separated by a semicolon.]
Last Modified: 5/17/2024 Location: FL, PR, USVI Business: Part B

Positron emission tomography (PET) for oncologic conditions: Modifier usage

The appeals department is receiving appeals regarding the incorrect usage of modifiers associated with PET scans. The modifiers PI or PS assist with the identification of the PET service for oncologic conditions. The PI or PS modifiers are only used for conditions associated with oncologic conditions. The usage of a PI or PS with PET services for non-oncologic conditions will result in a denial of the claim. To prevent unnecessary claim denials and appeals, follow the instructions below for usage of the PI or PS modifiers.
Modifiers PI or PS help identify the PET scan is related to oncology and they are required for all (2-[F18] fluoro-2-deoxy-D-glucose) (FDG) PET oncology related claims. When the radiopharmaceutical/tracer codes are billed they are required.
PI - Positron Emission Tomography (PET) or PET/Computed Tomography (CT) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing.
The PI modifier is only for PET to inform the initial treatment.
PS - Positron Emission Tomography (PET) or PET/Computed Tomography (CT) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the PET study is needed to inform subsequent anti-tumor strategy.
The PS modifier is only for PET to inform the subsequent anti-tumor strategy.
Please review the appropriate billing guidelines before submitting redetermination requests and submit your supporting documentation with the appeal request.
References
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.