Summary & Overview
HCPCS G0562: Radiopharmaceutical-Directed PET/CT Simulation and Modeling
HCPCS Level II code G0562 covers complex therapeutic radiology simulation that includes acquisition of PET and CT imaging data required for radiopharmaceutical-directed radiation therapy treatment planning. The code captures advanced modeling and field-setting services used when radiopharmaceuticals inform target delineation and dose calculations. Nationally, this code is relevant as radiopharmaceutical therapies and image-guided radiation planning expand, affecting facility workflows and claims reporting.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical and billing context for G0562, including typical sites of service and the service type. The publication provides benchmarks and payer coverage context where available, highlights coding and documentation implications for facilities performing multimodality simulation, and summarizes policy developments affecting radiopharmaceutical-directed radiation planning.
This summary is intended for administrators, billing professionals, and clinical leaders seeking a national-level briefing on the purpose and operational relevance of HCPCS Level II code G0562 in contemporary radiation oncology practice.
Billing Code Overview
HCPCS Level II code G0562 describes a complex therapeutic radiology simulation and field setting service that includes acquisition of PET and CT imaging data required for radiopharmaceutical-directed radiation therapy treatment planning (i.e., modeling). This service represents an advanced simulation process used when radiopharmaceuticals guide radiation targeting and dose modeling.
Service type: Therapeutic radiology simulation with multimodality imaging for radiopharmaceutical-directed treatment planning
Typical site of service: Hospital outpatient departments, freestanding radiation oncology centers, or advanced imaging centers
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a confirmed or suspected neuroendocrine tumor or metastatic prostate cancer scheduled for radiopharmaceutical-directed external beam radiation therapy or peptide receptor radionuclide therapy planning. The patient arrives to the radiation oncology department on the simulation day after referral from medical oncology or nuclear medicine. The clinical workflow includes verification of staging imaging, review of prior PET and CT studies, and intravenous contrast assessment when indicated. The technologist and simulation therapist perform immobilization and acquire a CT simulation dataset in the treatment position, with or without contrast, using appropriate immobilization devices (e.g., custom mask, body mold). A PET/CT (or separately acquired PET and CT datasets) are obtained or imported and fused with the simulation CT for target delineation. Complex field setting and modeling are completed by the dosimetrist and radiation oncologist, incorporating PET metabolic information and CT anatomic detail to generate treatment volumes, heterogeneity corrections, and dose calculations specific to radiopharmaceutical-directed planning. The procedure includes multidisciplinary review, image registration quality checks, and creation of beam arrangements or model parameters for subsequent treatment delivery. Typical site of service is an outpatient radiation oncology department, freestanding radiation center, or hospital-based radiation therapy suite where PET/CT imaging and treatment planning resources are available.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
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