The recent FDA approval of two new PET tracers, Tauvid and Detectnet, can provide additional PET imaging opportunities to radiology practices. In this article, we cover the recommended reporting of these services to both Medicare and private payers. Learn more about these PET coding updates here.
Tau PET Imaging
After completing two clinical trials, the FDA recently approved Tauvid (flortaucipir F18) for use in Brain PET imaging. Tauvid is indicated for PET imaging of the brain to estimate density and distribution of aggregated tau neurofibrillary tangles (NFTs) as a primary marker of Alzheimer’s disease. Until there is a specific HCPCS issued for Tauvid, it must be reported with the unlisted HCPCS code A9598 (PET radiopharmaceutical, non-oncologic). Global imaging centers would be advised to let their coding and billing staff know if they are utilizing the 30mL or 50 mL multiple dose vial in order to ensure the appropriate NDC # appears on the claim. It should be noted that A9598 is historically paid at carrier discretion.
Tau PET has only been reimbursed under clinical trial guidelines, and there are currently no published coverage policies. The National Coverage Determination (NCD) 220.6.19 addresses oncologic indications for FDG PET, and therefore, until guidance is received from CMS, Tau PET imaging should be reported to Medicare using the noncovered PET code G0235. The applicable PET CPT code (78811-78816) can be reported to private carriers. Per Clinical Examples in Radiology, Summer 2017, Brain PET; metabolic evaluation (CPT 78608) is specifically for FDG studies. More information can be seen at this link toThe Journal of Nuclear Medicine August 2020.
Detectnet PET Imaging
Detectnet (copper Cu64 dotatate) was approved by the FDA in September 2020 for use with PET for localization of somatostatin receptor positive neuroendocrine tumors (NETs) in adult patients. Previously, Netspot (Ga68) was the only approved PET tracer for evaluation of NETs. Detectnet has a longer half-life than Netspot which allows for more flexibility in ordering doses and scheduling patients. Until there is a specific HCPCS issued for Detectnet, it must be reported with the unlisted HCPCS code A9597 (PET radiopharmaceutical, for tumor identification). Detectnet is packaged as a single-dose, single-use vial (NDC # 69945-0064-01). It should be noted that A9597 is historically paid at carrier discretion.
There are currently no published coverage policies. The National Coverage Determination (NCD) 220.6.19 addresses oncologic indications for FDG PET, and therefore, until guidance is received from CMS, Detectnet PET imaging should be reported to Medicare using the noncovered PET code G0235. The applicable PET CPT code (78811-78816) can be reported to private carriers.
Updated guidance for both Tauvid and Detectnet will be provided as it becomes available.
By: Mindy Mincho, CPC, RCC, Corporate Coding Manager – Diagnostic Radiology and E/M
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