How To Use HCPCS Code A9586

HCPCS code A9586 describes the diagnostic radiology procedure for Florbetapir F18. This code is used to identify the administration of Florbetapir F18, a radioactive diagnostic agent used in positron emission tomography (PET) scans to detect amyloid plaques in the brain. In this article, we will explore the details of HCPCS code A9586, including its official description, procedure, usage guidelines, billing requirements, historical information, and coverage by Medicare and insurance providers.

1. What is HCPCS A9586?

HCPCS code A9586 is used to identify the administration of Florbetapir F18, a diagnostic radiology procedure. Florbetapir F18 is a radioactive diagnostic agent that is injected into the patient’s bloodstream prior to a PET scan. It is specifically used to detect amyloid plaques in the brain, which are associated with Alzheimer’s disease. This code is used to report the administration of Florbetapir F18 per study dose, up to 10 millicuries.

2. Official Description

The official description of HCPCS code A9586 is “Florbetapir F18, diagnostic, per study dose, up to 10 millicuries.” This description accurately reflects the purpose and dosage limitations of this diagnostic radiology procedure. The short description for this code is “Florbetapir F18.”

3. Procedure

1. The procedure for HCPCS code A9586 involves the administration of Florbetapir F18 to the patient.
2. The healthcare provider prepares the Florbetapir F18 solution according to the manufacturer’s instructions.
3. The provider then injects the Florbetapir F18 solution into the patient’s bloodstream.
4. After the injection, the patient undergoes a PET scan to visualize the distribution of the radioactive agent in the brain.
5. The PET scan images are then interpreted by a radiologist or other qualified healthcare professional to assess the presence of amyloid plaques.

4. When to use HCPCS code A9586

HCPCS code A9586 should be used when a healthcare provider administers Florbetapir F18 to a patient for the purpose of conducting a PET scan to detect amyloid plaques in the brain. This code is specific to the diagnostic use of Florbetapir F18 and should not be used for other radiopharmaceuticals or diagnostic procedures.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9586, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the administration of Florbetapir F18, including the dosage and route of administration.
• Documentation of the PET scan procedure and its interpretation.
• Supporting medical records that justify the medical necessity of the procedure.

Providers should also follow the appropriate billing guidelines and submit the claim with the necessary supporting documentation to ensure accurate reimbursement for the service.

6. Historical Information and Code Maintenance

HCPCS code A9586 was added to the Healthcare Common Procedure Coding System on January 01, 2013. As of January 01, 2024, there is a payment change associated with this code. The pricing indicator code for A9586 is 00, indicating that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the value for this code is not established.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code A9586 may vary. Providers should refer to the Medicare coverage guidelines and policies of individual insurance carriers to determine the coverage and reimbursement for this procedure. The pricing indicator code of 00 indicates that the service is not separately priced by Part B, and the multiple pricing indicator code of 9 indicates that the value for this code is not established.

8. Examples

Here are five examples of scenarios where HCPCS code A9586 should be billed:

1. A patient with suspected Alzheimer’s disease undergoes a PET scan with Florbetapir F18 to assess the presence of amyloid plaques in the brain.
2. A research study requires the administration of Florbetapir F18 to participants for the purpose of studying the distribution of amyloid plaques in the brain.
3. A patient with a family history of Alzheimer’s disease undergoes a PET scan with Florbetapir F18 as a preventive measure.
4. A healthcare provider orders a PET scan with Florbetapir F18 to monitor the progression of amyloid plaques in a patient with known Alzheimer’s disease.
5. A patient with cognitive impairment undergoes a PET scan with Florbetapir F18 to aid in the diagnosis of Alzheimer’s disease.