Question 1

What is HCPCS code G0252?

Accepted Answer

HCPCS code G0252 is "Pet imaging initial dx". Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes)

Question 2

What category is G0252 in?

Accepted Answer

G0252 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0252?

Accepted Answer

Use G0252 when billing for pet imaging initial dx. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

What ICD-10 codes are commonly used with G0252?

Accepted Answer

Common ICD-10 diagnosis codes used with G0252 include: D86.85 (Sarcoid myocarditis), F03.90 (Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety), F03.911 (Unspecified dementia, unspecified severity, with agitation), F03.918 (Unspecified dementia, unspecified severity, with other behavioral disturbance). Always ensure proper medical documentation supports the medical necessity for the HCPCS code being billed.

Question 5

Is G0252 covered by Medicare?

Accepted Answer

Coverage for G0252 (Pet imaging initial dx) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 6

What documentation is required for G0252?

Accepted Answer

Documentation for G0252 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).