Reimbursement for PET Procedures

  • Gopal B. Saha


Healthcare providers (physicians, hospitals, clinics, etc.) operate and are sustained by the reimbursement or payment for care they provide to patients. In the United States, revenue for healthcare services comes from a variety of sources including the patient, insurance companies (i.e., BlueCross/BlueShield, Cigna, Aetna), and the Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA). The CMS provides healthcare insurance for Medicare and Medicaid beneficiaries. When interfacing with an insurance company or the CMS, there are three fundamental reimbursement concepts that must be considered to assure appropriate revenue for services provided. These include the concepts of coverage, coding, and payment.


Diagnosis Related Group Current Procedural Terminology Current Procedural Terminology Code Health Care Financing Administration Healthcare Common Procedure Code System 
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References and Suggested Reading

  1. AMA (2009). CPT codes, professional edition. The American Medical Association, Chicaco, ILGoogle Scholar
  2. Human Drugs: Positron Emission Tomography Drug Products: Safety and Effectiveness. (2000). Food and Drug Administration notices. Federal Register, March 10, 65:12999Google Scholar
  3. Keppler JS (2001). Federal regulations and reimbursement for PET. J Nucl Med Technol 29:173PubMedGoogle Scholar
  4. Medicare: Hospital Outpatient Services: Prospective Payment System (2001). Centers for Medicare and Medicaid Services proposed rules. Fed Regist 66:44671Google Scholar
  5. Medicare Hospital Outpatient Services: Prospective Payment System. (2002). Health care financial rules. Fed Regist 65:18433Google Scholar
  6. Medicare National Coverage Determinations Manual. (2009). pub 100–03
  7. Positron Emission Tomography (PET) Scans, Medicare Coverage Issues Manual, Section50–36, Transmittal R147 (2002). downloads/R147cim.pdf
  8. Society of Nuclear Medicine Physician Coding & Reimbursement Committee (2005). Educational Material on coding PET/CT with Integrated PET systems. (updated, 2006)Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Gopal B. Saha
    • 1
  1. 1.Department of Nuclear MedicineThe Cleveland Clinic FoundationClevelandUSA

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