How To Use HCPCS Code G0219

HCPCS code G0219 describes a specific procedure known as Pet imaging whole body for melanoma, but only for non-covered indications. This code is not eligible for reimbursement by Medicare and does not have any maintenance actions associated with it. In this article, we will explore the details of HCPCS code G0219, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0219?

HCPCS code G0219 is used to identify the procedure of Pet imaging whole body for melanoma, but only for non-covered indications. This code is specific to diagnostic radiology services and is not eligible for reimbursement by Medicare.

2. Official Description

The official description of HCPCS code G0219 is “Pet imaging whole body; melanoma for non-covered indications.” The short description is “Pet img wholbod melano nonco.”

3. Procedure

1. The Pet imaging whole body procedure involves the use of positron emission tomography (PET) technology to capture detailed images of the entire body.
2. During the procedure, the patient is injected with a radioactive tracer substance that is absorbed by the body’s cells.
3. The PET scanner then detects the radiation emitted by the tracer substance and creates images that can help in the diagnosis and staging of melanoma.
4. The procedure is typically performed in a specialized imaging facility or hospital setting.
5. It is important for the healthcare provider to follow all safety protocols and guidelines when performing the procedure.

4. When to use HCPCS code G0219

HCPCS code G0219 should be used when performing a whole body PET imaging procedure specifically for melanoma, but only for non-covered indications. It is important to ensure that the procedure meets the criteria for non-covered indications as defined by Medicare or other insurance providers.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0219, healthcare providers need to document the medical necessity of the procedure and provide supporting documentation, such as the patient’s medical history, physician’s order, and any relevant diagnostic test results. It is important to follow the specific billing guidelines and requirements set forth by Medicare or other insurance providers.

6. Historical Information and Code Maintenance

HCPCS code G0219 was added to the Healthcare Common Procedure Coding System on July 01, 2001. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code G0219 is classified as non-covered by Medicare, meaning it is not eligible for reimbursement. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. It is important to check with other insurance providers regarding their coverage policies for this specific procedure.

8. Examples

Here are five examples of when HCPCS code G0219 should be billed:

1. A patient with a history of melanoma undergoes a whole body PET imaging procedure for non-covered indications to monitor the progression of the disease.
2. A physician orders a PET imaging whole body procedure for a patient suspected of having metastatic melanoma, but the procedure is not covered by Medicare due to the specific indications.
3. A patient with a known melanoma diagnosis undergoes a PET imaging whole body procedure for non-covered indications to assess the response to treatment.
4. A healthcare provider performs a PET imaging whole body procedure for a patient with a suspected recurrence of melanoma, but the procedure is not covered by Medicare.
5. A patient with a family history of melanoma undergoes a PET imaging whole body procedure for non-covered indications as a preventive measure.