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.
- 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.
- 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.
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