2025 HCPCS code G0252
PET imaging, full and partial-ring PET scanners, for initial diagnosis of breast cancer and/or surgical planning.
While G0252 is generally not covered by Medicare for initial diagnosis or surgical planning of breast cancer, it's crucial to consult specific payer guidelines, as coverage may vary. Medical necessity should be demonstrably justified with supporting clinical evidence and documentation following payer-specific requirements.
The provider injects a radioactive tracer into the patient's bloodstream. The tracer emits gamma rays which are detected by the PET scanner. The scanner creates images of the axillae to identify cancer in axillary lymph nodes and assist in surgical planning.
In simple words: A PET scan uses a special dye to create pictures of the inside of the body. This code is for using a PET scan to look for breast cancer or to help doctors plan breast cancer surgery. The scan can also show if cancer has spread to lymph nodes under the arm.
Positron emission tomography (PET) imaging using full and partial-ring PET scanners for the initial diagnosis of breast cancer and/or surgical planning, including the initial staging of axillary lymph nodes.
Example 1: A patient with a suspected breast lump undergoes a PET scan with G0252 to determine if the lump is cancerous and evaluate the extent of the disease., A patient newly diagnosed with breast cancer undergoes a PET scan with G0252 to assess the involvement of axillary lymph nodes before surgery., A patient with locally advanced breast cancer undergoes a PET scan with G0252 to aid in surgical planning for breast-conserving surgery or mastectomy.
Documentation should support the medical necessity of the PET scan, including the patient's history, physical exam findings, imaging studies (mammogram, ultrasound), biopsy results (if available), and the rationale for using PET for initial diagnosis or surgical planning.
** This code is specific to full and partial-ring PET scanners and does not apply to other imaging modalities. It is important to verify coverage policies with individual payers as Medicare considers this use of PET scanning not medically necessary. While current information suggests limited coverage, consult up-to-date payer guidelines and iFrameAI for the latest details.
- Payment Status: Non-covered by Medicare
- Specialties:Oncology, Surgery, Radiology, Nuclear Medicine
- Place of Service:Office, Independent Clinic, Outpatient Hospital, Ambulatory Surgical Center