US · guidance
CMS Pub. 100-04, ch. 13, § 60.17
Billing and Coverage Changes for PET Scans for Cervical
Cancer Effective for Services on or After November 10, 2009
(Rev. 3650, Issued: 11-10-16, Effective: 02-10-17, Implementation: 02-10-17)
A. Billing Changes for A/B MACs (A and B)
Effective for claims with dates of service on or after November 10, 2009, contractors
shall accept FDG PET oncologic claims billed to inform initial treatment strategy;
specifically for staging in beneficiaries who have biopsy-proven cervical cancer when the
beneficiary’s treating physician determines the FDG PET study is needed to determine
the location and/or extent of the tumor as specified in Pub. 100-03, section 220.6.17.
EXCEPTION: CMS continues to non-cover FDG PET for initial diagnosis of cervical
cancer related to initial treatment strategy.
NOTE: Effective for claims with dates of service on and after November 10, 2009, the –
Q0 modifier is no longer necessary for FDG PET for cervical cancer.
B. Medicare Summary Notices, Remittance Advice Remark Codes, and Claim
Adjustment Reason Codes
Additionally, contractors shall return as unprocessable /return to provider for FDG PET
for cervical cancer for initial treatment strategy billed without the following: one of the
PET/PET/ CT CPT codes listed in 60.16 C above AND modifier PI AND a cervical
cancer diagnosis code.
The contractor shall use the following remittance advice messages and associated codes
when returning claims under this policy. This CARC/RARC combination is compliant
with CAQH CORE Business Scenario Two.
Group Code: CO
CARC: 4
RARC: MA130
MSN: N/A
History
(Rev. 3650, Issued: 11-10-16, Effective: 02-10-17, Implementation: 02-10-17)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
999526a20815d1af04fadb7748e2cf74f5956533b46179ee4f65e82bc11e648c
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