2025 HCPCS code PS

Modifier PS is used with PET or PET/CT scans to indicate that the study is being performed to determine the subsequent treatment strategy for cancerous tumors when the treating physician deems it necessary to inform the anti-tumor strategy.

Modifier PS should be appended to the appropriate PET procedure codes (e.g., 78608, 78811-78816) when billing for a PET or PET/CT scan performed to determine the subsequent treatment strategy for cancerous tumors. When billing for the professional component only, append modifier 26 first, and then append modifier PS. When billing for the technical component only, append modifier TC first, and then append modifier PS.

Modifiers 26 and TC can be used in conjunction with PS depending on whether the professional or technical component is being billed.

The PET study must be medically necessary for informing the subsequent treatment strategy of cancerous tumors.The documentation should clearly demonstrate the clinical rationale and support the need for the study.

The treating physician is responsible for determining the need for the PET study to inform the subsequent anti-tumor strategy.

IMPORTANT Use modifier PI for initial treatment strategy of tumors.

In simple words: This code is used when a doctor orders a PET or CT scan to help decide on the next steps in treating a patient's cancer.

Positron emission tomography (PET) or PET/computed tomography (CT) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the PET study is needed to inform subsequent anti-tumor strategy.

Example 1: A patient with recurrent prostate cancer undergoes a PET scan to determine the best course of treatment after initial therapy has failed., A patient with a cancerous tumor undergoes a PET/CT scan to evaluate treatment response and guide further management., A patient with a history of cancer undergoes a PET scan to assess for possible recurrence and guide treatment decisions.

Documentation should support the medical necessity of the PET study for determining the subsequent treatment strategy of cancerous tumors. This may include details about the patient's cancer diagnosis, prior treatment history, and the physician's rationale for ordering the PET scan.

** Modifier PS is specific to oncologic conditions and should not be used for non-oncologic PET scans. Ensure the diagnosis code supports the use of this modifier.

  • Modifier TC rule: Modifier TC can be appended before modifier PS when billing for the technical component only.
  • Specialties:Oncology, Radiology, Nuclear Medicine
  • Place of Service:Office, Outpatient Hospital, Independent Clinic, Freestanding Imaging Center
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