How To Use HCPCS Code A9544

HCPCS code A9544 describes the use of iodine i-131 tositumomab for diagnostic purposes. This code is used to identify the administration of this radiopharmaceutical agent for diagnostic imaging studies. In this article, we will explore the details of HCPCS code A9544, 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 A9544?

HCPCS code A9544 is used to identify the administration of iodine i-131 tositumomab for diagnostic purposes. This code specifically refers to the study dose of this radiopharmaceutical agent. It is important to note that HCPCS codes are used for reporting medical procedures and services, and A9544 is specifically used for diagnostic radiology.

2. Official Description

The official description of HCPCS code A9544 is “Iodine i-131 tositumomab, diagnostic, per study dose.” This description accurately reflects the purpose and usage of this code. The short description of this code is “I131 tositumomab, dx.”

3. Procedure

1. The procedure for HCPCS code A9544 involves the administration of iodine i-131 tositumomab for diagnostic imaging studies.
2. The provider will prepare the necessary dosage of iodine i-131 tositumomab according to the specific study requirements.
3. The radiopharmaceutical agent will be administered to the patient through a suitable route, such as intravenous injection or oral ingestion, depending on the specific diagnostic imaging study.
4. After the administration, the patient will undergo the necessary imaging procedures, such as PET scans or SPECT scans, to obtain diagnostic information.
5. The provider will interpret the imaging results and use them for diagnostic purposes.

4. When to use HCPCS code A9544

HCPCS code A9544 should be used when iodine i-131 tositumomab is administered for diagnostic purposes. This code is specifically for the study dose of this radiopharmaceutical agent and should not be used for therapeutic purposes. It is important to follow the specific guidelines and eligibility criteria for using this code, as determined by the carrier’s judgment.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9544, healthcare providers need to document the administration of iodine i-131 tositumomab for diagnostic purposes. This documentation should include the dosage administered, the route of administration, and the specific diagnostic imaging study performed. It is important to ensure accurate and detailed documentation to support the medical necessity of the procedure.

6. Historical Information and Code Maintenance

HCPCS code A9544 was added to the Healthcare Common Procedure Coding System on January 01, 2006. It has an effective date of January 01, 2017, indicating that it is still an active code. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important to stay updated with any changes or revisions related to this code.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code A9544 may vary. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology. It is important to verify the coverage and reimbursement policies of Medicare and other insurance providers to ensure proper billing and reimbursement for this code.

8. Examples

Here are five examples of when HCPCS code A9544 should be billed:

1. A patient undergoes a PET scan with iodine i-131 tositumomab for the diagnostic evaluation of lymphoma.
2. A provider administers iodine i-131 tositumomab for a SPECT scan to assess the extent of thyroid cancer metastasis.
3. A diagnostic imaging study is performed using iodine i-131 tositumomab to evaluate the response to treatment in a patient with non-Hodgkin’s lymphoma.
4. A provider uses iodine i-131 tositumomab for a diagnostic imaging study to detect the presence of residual tumor cells in a patient with breast cancer.
5. A patient undergoes a diagnostic imaging study with iodine i-131 tositumomab to assess the effectiveness of radioiodine therapy in treating thyroid cancer.