radiopharmaceutical therapy by intravenous administration cpt code

List Of CPT Codes For Radiopharmaceuticals (2021)

Radiopharmaceuticals are used in the field of nuclear medicine as tracers in the diagnosis and treatment of many diseases. Many radiopharmaceuticals use technetium-99m (Tc-99m) which has many useful properties as a gamma-emitting tracer nuclide. In the book Technetium a total of 31 different radiopharmaceuticals based on Tc-99m are listed for imaging and functional studies of the brain, myocardium, thyroid, lungs, liver, gallbladder, kidneys, skeleton, blood and tumors.

When radiopharmaceuticals are injected into the body, they emit a radioactive signal which can be traced with special cameras or computers. The amount of radiation a patient is subjected to is about the same as a normal x-ray, but the information gathered is significantly different.

Coders should check the radiopharmaceuticals current HCPCS code description carefully. The codes description defines one unit of service.

The following examples include radiopharmaceutical therapy by intravenous administration cpt code.

Coding For Radiopharmaceuticals Agents

Most radiopharmaceuticals that have their own code include in the code’s description “per study dose” and include a range of mCi’s (millicurie). These radiopharmaceutical agents should be billed as one unit of service per study. It is not appropriate to bill per mCi for the codes that include per study dose in its HCPC’s description. It would be unusual to have more than 2 units of service for most of the agents with a per study dose or per treatment in its description.

Example: A9503 is defined as Technetium Tc 99m, Medronate, (MDP), diagnostic, per study dose, up to 30 mCi’s). Per study dose, up to 30 millicuries is one unit of service. If the provider administers one to 30mCi of this agent for a study, it should be billed as one unit of service.

Some radiopharmaceutical code descriptions are defined as per millicurie (mCi). These agents should be billed per millicurie. The number of mCi’s that were administered to the patient should be the same as the number of services listed in the unit field on the claim.

Example: A9512 is defined as Technetium Tc-99m-Pertechnetate, Diagnostic, per mCi. If you administer 5 mCi of this agent to your patient then 5 would be listed in the units’ field of the claim.

NOC radiopharmaceutical codes (A4641, A9699) should be billed with one unit of service. The claim must include the name and total dosage of the agent in item 19 of the CMS 1500 form, or the electronic equivalent for EMC.

The following radiopharmaceuticals will be considered medically necessary when used with the procedures listed below.

CPT Codes For Technetium (Tc) Labeled Radiopharmaceutical

  1. A9557: Technetium Tc-99m Bicisate (Neurolite®), Diagnostic, per study dose, up to 25 mCi’s
    CPT 78600 – CPT 78607, CPT 78610: Brain imaging.
  2. A9551: Technetium Tc-99m Succimer (DMSA), Diagnostic, per study dose, up to 10 mCi’s,
    CPT-4 Codes, CPT 78700 – CPT 78710: Parenchymal renal scan.
    CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Tumor detection.
  3. A9539: Technetium Tc-99m Pentetate, Diagnostic, per study dose, up to 25 mCi’s,
    CPT 78579, CPT 78580, CPT 78582, CPT 78597, CPT 78598: Lung ventilation.
    CPT 78761: Testicular imaging with vascular flow.
    CPT 78700 – CPT 78725: GFR renal scan.
    CPT 78730: Urinary bladder residual.
    CPT 78740: Ureteral reflux.
    CPT 78630 – CPT 78650: CSF study.
    CPT 78600 – CPT 78607, CPT 78610: Brain study.
    CPT 78291, CPT 78645: Shunt patency agent. 500 uCi
    CPT 78481, CPT 78483: First-pass cardiac technique studies.
    CPT 78445: Vascular flow study.
    CPT 78428: Cardiac Shunt detection
  4. A9567: Technetium Tc-99m Pentetate, Diagnostic, aerosol, per study dose, up to 75 mCi’s
    CPT 78579, CPT 78580, CPT 78582, CPT 78597, CPT 78598: Lung ventilation.
  5. A9510: Technetium Tc-99m Disofenin (Hepatolite, DISIDA), per study dose, up to 15 mCi’s
    CPT 78226 & CPT 78227: Hepatobiliary scan agent.
  6. A9521: Technetium Tc-99m Exametazine (Ceretec®), Diagnostic, per study dose, up to 25 mCi’s.
    CPT 78600 – CPT 78607, CPT 78610: Brain perfusion.
  7. A9569: Technetium TC-99m Exametazime labeled autologous white blood cells, Diagnostic, per study dose.
    CPT 78805, CPT 78806, CPT 78807: Infection detection
  8. A4641: TechnetiumTc-99m Human Serum Albumin Usual Dosage 2-20 mCi.
    CPT 78630 – CPT 78652: CSF Leak Study.
    CPT 78414 – CPT 78458: Blood pool agent.
    CPT 78195: Lymphatic imaging.
  9. A4641: Technetium Tc-99m Iminodiacetic Acid (IDA) Usual Dosage 5-12 mCi.
    CPT 78226, CPT 78227: Hepatobiliary scan agent.
  10. A9540: Technetium Tc-99m Macroaggregated Albumin (MAA), Diagnostic, per study dose, up to 10 mCi’s.
    CPT 78580, CPT 78582, CPT 78597, CPT 78598: Lung perfusion agent.
    CPT 78291: Peritoneal-Venous Shunt Study.
    CPT 78800, CPT 78801, CPT 78803: Peritoneal cavity imaging prior to intraperitoneal chemotherapy.
    CPT 78216, CPT 78428: Cardiac Shunt Detection.
    CPT 78201, CPT 78205, CPT 78215: Liver imaging (SPECT).
  11. A9537: Technetium Tc-99m Mebrofenin (Choletec) Diagnostic, per study dose, up to 15 mCi’s.
    CPT 78226, CPT 78227: Hepatobiliary scan agent.
  12. A9562: Technetium Tc-99m Mertiatide (MAG-3), diagnostic, per study dose, up to 15 mCi’s.
    CPT 78700 – CPT 78725: Renal scan agent.
  13. A9503: Technetium Tc 99m, Medronate, (MDP), diagnostic, per study dose, up to 30 mCi’s.
    CPT 78300 – CPT 78320, CPT 78399: Bone scan.
  14. A9561: Technetium Tc-99m Oxidronate, Diagnostic, per study dose, up to 30 mCi’s.
    CPT 78300 – CPT 78320, CPT 78399: Bone scan agent.
  15. A9512: Technetium Tc-99m-Pertechnetate, Diagnostic, per mCi.
    CPT 78000, CPT 78001, CPT 78006, CPT 78007, CPT 78010, CPT 78011, CPT 78015: Thyroid study.
    CPT 78600, CPT 78601, CPT 78602, CPT 78603, CPT 78604, CPT 78605, CPT 78606, CPT 78607, CPT 78610: Brain death.
    CPT 78481, CPT 78483: First-pass cardiac technique studies.
    CPT-4 Codes, CPT 78261, CPT 78290: Meckel’s diverticulum 10-20 mCi.
    CPT 78070: Parathyroid study.
    CPT 78230, CPT 78231, CPT 78232: Parotid or salivary scan.
    CPT 78261, CPT 78290: Gastric mucosa.
    CPT 78730: Urinary bladder residual.
    CPT 78740: Ureteral reflux study.
    CPT 78660: Dacryocystography.
    CPT 78761: Testicular imaging with vascular flow.
    CPT 78291: Peritoneal-Venous Shunt Study.
    CPT 78630 – CPT 78650: Cerebrospinal Fluid study.
  16. A9538: Technetium Tc-99m Pyrophosphate (PYP) (Pyrolite®) Diagnostic, per study dose, up to 25 mCi’s.
    CPT 78300 – CPT 78320: Bone.
    CPT 78999: Amyloid imaging.
    CPT 78466 – CPT 78469: Myocardial Infarct imaging.
  17. A9560: Technetium Tc-99m Labeled Red Blood Cell’s (RBC’s) Diagnostic, per study dose, up to 30 mCi’s, (Ultra Tag ® or cold pyrophosphate (pyp) +99m technetium),
    CPT 78472, CPT 78473, CPT 78494, CPT 78496: Cardiac blood pool imaging / Gated Equilibrium studies.
    CPT 78278: GI bleed study.
    CPT 78201, CPT 78202, CPT 78203, CPT 78204, CPT 78205, CPT 78206: Liver scan (for Hemangioma).
    CPT 78445: Vascular flow study.
    CPT 78457, CPT 78458: Venous thrombosis imaging.
    CPT 78215, CPT 78216, CPT 78185: Spleen imaging.
  18. A9500: Technetium Tc-99m, Sestamibi, diagnostic, per study dose.
    CPT 78451, CPT 78452, CPT 78453, CPT 78454: Cardiac perfusion.
    CPT 78070: Parathyroid study.
    CPT 78605, CPT 78606, CPT 78607, CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Tumor
    CPT 78800, CPT 78801: Breast tumor.
  19. A9541: Technetium Tc-99m Sulfur Colloid, Diagnostic, per study dose, up to 20 mCi’s.
    CPT 78201 -CPT 78216: Liver spleen scans.
    CPT 78185: Spleen scan.
    CPT 78278: GI bleed studies.
    CPT 78102, CPT 78103, CPT 78104: Bone marrow studies.
    CPT 78264, CPT 78299: Gastric emptying, gastric emptying with colonic transit studies.
    CPT 78258, CPT 78262: Gastroesophageal reflux studies.
    CPT 78740: Ureteral reflux study.
    CPT 78730: Urinary bladder residual study.
    CPT 78195: Lymphatics & Lymph glands.
    CPT 78291: Peritoneal-pleural shunt studies.
  20. A9502: Technetium Tc 99m tetrofosmin, diagnostic, per study dose, (Myoview).
    CPT 78451, CPT 78452, CPT 78453, CPT 78454: Myocardial perfusion studies.
    CPT 78070, CPT 78803: Parathyroid study.

CPT Codes For Iodine Labeled Radiopharmaceuticals

I 123

  1. A4641: Hippurate (Orthoiodohippurate) Usual Dosage 150-250 uCi
    CPT 78700 – CPT 78725: Renogram.
  2. A9516: Iodine I-123 Sodium iodide capsule(s), Diagnostic, per 100 Microcuries, up to 999 microcuries
    CPT 78000 – CPT 78018, CPT 78020, CPT 78070: Thyroid imaging.
  3. A9509: Iodine I-123 Sodium Iodide, diagnostic, per millicurie.
    CPT 78000 – CPT 78018, CPT 78020, CPT 78070: Thyroid imaging.
  4. A9582: Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries (AdreView®)
    CPT 78075: Adrenal imaging/ Pheochromocytoma.
    CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Neuroblastoma imaging.
  5. A9584: Iodine I-123 ioflupane, diagnostic, per study dose, up to 5 millicuries (DaTscan, ¢-FDA approved 01/14/2011).
    CPT 78607: Brain Imaging, tomographic (SPECT)

I 125

  1. A9554: Iodine-125 sodium iothalamate (Glofil-125®), Diagnostic, per study dose, up to 10 microcuries.
    CPT 78707, CPT 78708, CPT 78709, CPT 78725: Renogram.
  2. A9532: Iodinated I-125-Serum Albumin, Diagnostic, per 5 microcuries.
    CPT 78110, CPT 78111, CPT 78122: Plasma Volume.
  3. A9527: Iodine- 125 Sodium Iodide solution, Therapeutic, per millicurie.
    CPT 79005: Hyperthyroidism or thyroid cancer.
    CPT 77761: Intracavitary radiation source application, simple.

I 131

  1. A4641: Hippurate (Orthoiodohippurate), Usual Dosage 150-250 uCi
    CPT 78707, CPT 78708, CPT 78709, CPT 78725: Renogram.
  2. A9508: Iobenguane sulfate-Metaiodobenzyl guanidine (MIBG) per 0.5 mCi.
    CPT 78075: Adrenal imaging/ Pheochromocytoma.
    CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Neuroblastoma imaging.
  3. A9517: Iodine I-131 Sodium Iodide capsule(s), Therapeutic, per mCi.
    CPT 79005: Hyperthyroidism or thyroid cancer.
  4. A9530: Iodine I-131 Sodium Iodide solution, Therapeutic, per mCi.
    CPT 79005: Hyperthyroidism or thyroid cancer.
  5. A9528: Iodine I-131 Sodium Iodide capsule(s), Diagnostic, per mCi.
    CPT 78000 – CPT 78020, CPT 78803: Thyroid uptake and imaging.
  6. A9529: Iodine I-131 Sodium Iodide solution, Diagnostic, per mCi.
    CPT 78000 – CPT 78020, CPT 78803: Thyroid uptake and imaging.
  7. A9531: Iodine I-131 Sodium Iodide, Diagnostic, per microcurie (up to 100 microcuries).
    CPT 78000 – CPT 78020, CPT 78803: Thyroid uptake and imaging.
  8. A9544: Iodine I-131 Tositumomab, (Bexxar®) Diagnostic, per study dose.
    CPT 78804: Tumor imagingIodine I-131 Tositumomab, (Bexxar®) Therapeutic, per treatment dose.
    CPT 79403: Radiopharmaceutical therapy, radiolabeled monoclonal antibody by IV infusion.
  9. A9524: Iodinated I-131-Serum Albumin, diagnostic, per 5 microcuries.
    CPT 78110, CPT 78111, CPT 78122: Plasma Volume.
    CPT 78600, CPT 78607, CPT 78610: Brain imaging.
    CPT 78580, CPT 78582, CPT 78597, CPT 78598: Pulmonary perfusion imaging.
    CPT 78451, CPT 78452, CPT 78453, CPT 78454: Cardiac imaging.
    CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Tumor imaging.
    CPT 7847, CPT 78473, CPT 78481, CPT 78482, CPT 78483: Cardiac Blood Pooling imaging.

CPT Codes For Indium Labeled Radiopharmaceuticals:

  1. A9507: Indium IN 111 Capromab Pendetide (ProstaScint®) per study dose, up to 10 mci’s.
    CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Tumor detection.
  2. A4641: Indium -111 Diethylenetriamine Pentaacetic acid (DTPA), Usual Dosage 500 uCi.
    CPT 78630 – CPT 78650: Cisternography or CSF leak detection, or shunt patency evaluation.
    CPT 78264: Gastric emptying.
  3. A9548: Indium IN-111 Pentetate Diagnostic, per 0.5 mCi (MPI INDIUM DTPA IN 111)
    CPT 78630: Cisternogram (cerebrospinal fluid flow)
    CPT 78635: Cerebrospinal ventriculography.
    CPT 78645: CSF Shunt evaluation.
    CPT 78647: Cerebrospinal fluid scan.
    CPT 78650: CSF Leakage detection and localization.
    CPT 78800: Localization of tumor or distribution of radiopharmaceutical agent.
  4. A9547: Indium-IN-111 Oxyquinoline, Diagnostic, per 0.5 mCi.
    CPT 78805, CPT 78806, CPT 78807, CPT 78185: Leukocyte labeling.
    CPT 78190, CPT 78191, CPT 78199: Platelet labeling.
  5. A9572: Indium-111 Pentetreotide (OctreoScan®), Diagnostic, per study dose, up to 6 millicuries.
    CPT 78075, CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804, CPT 78015-78018: Agent for localization of primary and metastatic neuroendocrine tumors bearing somatostatic receptors.
  6. A4642: Indium-111 Satumomab pendetide, diagnostic, per study dose, up to 6 mci’s (OncoScint®)
    CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Agent for imaging colorectal or ovarian cancers.
  7. A4641: Indium-111 Hydrochloride (HCL), Usual dosage 0.1-1.0 mCi
    CPT 78299: Gastric emptying with colonic transit study.
  8. A9570: Indium-111 labeled autologous white blood cells, diagnostic, per study dose.
    CPT 78805, CPT 78806, CPT 78807, CPT 78185: Leukocyte labeling.
  9. A9571: Indium in-111 labeled autologous platelets, diagnostic, per study dose.
    CPT 78190, CPT78191, CPT 78199: Platelet labeling.

CPT Codes For Miscellaneous Radiopharmaceuticals:

  1. A9553: Chromium CR-51 Sodium Chromate, Diagnostic, per study dose, up to 250 microcuries.
    CPT 78120, CPT 78121, CPT 78122: RBC Mass.
    CPT 78130, CPT 78131, CPT 78132, CPT 78133, CPT 78134, CPT 78135, CPT 78140: RBC Survival.
    CPT 78190, CPT 78191: Platelet Survival.
  2. A9556: Gallium Ga-67 Citrate, Diagnostic, per mCi.
    Used in scans searching for infections, inflammation, tumors (CPT 78800 – CPT 78807), and Sarcoidosis (CPT 78999)
  3. A9564: Chromic Phosphate P-32, suspension, Therapeutic, per mCi.
    CPT 79200: Therapeutic imaging agent for treatment of ovarian cancer.
    CPT 79300, CPT 79445: Interstitial radioactive colloid therapy.
  4. A9563: Sodium Phosphate P-32, Therapeutic, per mCi.
    CPT 79101: Therapeutic imaging agent for treatment of polycythemia vera or thrombocythemia.
  5. A9600: Strontium SR-89 Chloride (Metastron®), Therapeutic, per mCi.
    CPT 79101: Therapeutic for treatment of bone pain due to skeletal metastases.
  6. A9604: Samarium SM-153 Lexidronam (Quadramet®) Therapeutic, per treatment dose up to 150 millicuries.
    CPT 79101: Therapeutic for the treatment of pain in patients with confirmed osteoblastic metastatic bone lesions that enhance on radionuclide bone scan.
  7. A9505: Thallous Chloride TL-201, diagnostic, per mCi.
    CPT 78451, CPT 78452, CPT 78453, CPT 78454: Cardiac imaging.
    CPT 78070: Parathyroid imaging.
    CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Tumor imaging.
    CPT 78607: Brain imaging.
  8. A9558: Xenon Xe-133 Gas, Diagnostic, per 10 mCi’s.
    CPT 78579, CPT 78580, CPT 78582, CPT 78597, CPT 78598: Lung study.

Pet Scan radiopharmaceuticals

The payment for the radio-tracer or radiopharmaceuticals will be reimbursed for pet scans.

  1. A9555: Rubidium RB-82.
  2. A9552: Fluorodeoxyglucose (F-18 FDG).
  3. A9526: Ammonia N-13.

The following agents are no longer marketed in the United States and will be denied. Coverage will be added if the agent(s) become available in the future.

  1. A9501: Technetium Tc-99m Teboroxime (Cardiotec®).
  2. A9504: Technetium Tc 99m Apcitide (Acu Tect®).
  3. A9536: Technetium Tc-99M Depreotide, (Neotect®).
  4. A9550: Technetium Tc-99m Sodium Gluceptate (Glucoheptonate®).
  5. A9566: Technetium Tc-99m Fanolesomab, (NeutroSpec®).
  6. A9546: Cobalt CO-57-/58 Cyanocobalamin.
  7. A9559: Cobalt CO-57 Cyanocobalamin, oral.

Use of radiopharmaceuticals is regulated by the Nuclear Regulatory Commission (NRC) under strict procedures and guidelines. Persons administering radiopharmaceuticals should have either a license from the NRC or be credentialed by an institution having a broad license from the NRC.

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2 Comments

  1. Kay Larsen says:

    This article is a great resource! Are there any updates for 2021?

    1. Hi Kay, thanks. We didn’t look into changes for 2021 yet. Keep an eye on our website. We’ll look into it soon!

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