PET Modifiers

Description:
Positron Emission Tomography or PET/Computed Tomography (CT) to inform 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
Guidelines/Instructions.

This modifier is effective for dates of service on or after April 3, 2009, and may be submitted with the following CPT codes:

• All claims for CPT code 78608 and CPT codes 78811 through 78816 must be submitted with either HCPCS modifier PI or HCPCS modifier PS. If these CPT codes are submitted without one of these modifiers, the services will be 'returned as unprocessable' (rejected with remark code MA130, M16, and CO-4).

• To submit a claim for the professional component only: submit CPT modifier 26 in the first modifier position and HCPCS modifier PS (or HCPCS modifier PI) in the second modifier position.

• To submit a claim for the technical component only: submit HCPCS modifier TC in the first modifier position and HCPCS modifier PS (or HCPCS modifier PI) in the second modifier position.