Do you have any tips on the specific reporting requirements for code 78811?


For all PET procedures covered under a CMS-approved CED program (e.g., NOPR or IDEAS), hospital providers only must list condition code 30 and place Z00.6 in the second diagnosis position. Additionally, all outpatient providers should append the Q0 (zero) modifier to both the CPT® procedure code and the diagnostic radiopharmaceutical tracer to signify to Medicare, when a case is CED. Finally, add the eight-digit clinical trial number, which will be mandatory for claims with DOS on or after January 1, 2014. Do not use this code when PET/CT is performed on an integrated system (hardware fusion) and the CT is used for both attenuation correction and anatomic localization. Instead, see CPT codes 78814–78816.

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