How To Use HCPCS Code A9587

HCPCS code A9587 describes the use of Gallium ga-68, dotatate for diagnostic purposes. This code is used to identify the specific radiopharmaceutical agent and its dosage when conducting diagnostic imaging procedures. In this article, we will explore the details of HCPCS code A9587, 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 A9587?

HCPCS code A9587 is used to identify the radiopharmaceutical agent Gallium ga-68, dotatate, which is utilized for diagnostic imaging purposes. This code specifically represents a dosage of 0.1 millicurie. It is important to note that HCPCS codes are used by medical coders to accurately report and bill for specific healthcare services and supplies.

2. Official Description

The official description of HCPCS code A9587 is “Gallium ga-68, dotatate, diagnostic, 0.1 millicurie.” This description provides the necessary information to identify the specific radiopharmaceutical agent and its purpose.

3. Procedure

1. The procedure for HCPCS code A9587 involves the administration of Gallium ga-68, dotatate to the patient.
2. The dosage of the radiopharmaceutical agent is 0.1 millicurie.
3. The administration of Gallium ga-68, dotatate is typically done through intravenous injection.
4. After the administration, the patient undergoes diagnostic imaging, such as positron emission tomography (PET) scan, to visualize and evaluate specific areas of the body.
5. The diagnostic imaging helps in the detection and evaluation of certain types of tumors, such as neuroendocrine tumors.

4. When to use HCPCS code A9587

HCPCS code A9587 is used when conducting diagnostic imaging procedures that involve the use of Gallium ga-68, dotatate. This code is specifically applicable for the radiopharmaceutical agent and dosage mentioned in the official description. It is important to follow the specific guidelines and eligibility criteria set by the healthcare provider or payer when using this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9587, healthcare providers need to ensure proper documentation of the administration of Gallium ga-68, dotatate and the associated diagnostic imaging procedure. The documentation should include details such as the dosage administered, the route of administration, and the specific diagnostic imaging performed. Additionally, providers should follow the billing guidelines set by the payer to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code A9587 was added to the Healthcare Common Procedure Coding System on January 01, 2017. As of the effective date of January 01, 2024, this code has a coverage code of C, indicating that carrier judgment is used to determine coverage. The pricing indicator code for A9587 is 57, which signifies 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. There have been no maintenance actions taken for this code as of the provided information.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code A9587 may vary. It is important to consult the specific guidelines and policies of the payer to determine coverage and reimbursement. The pricing indicator code and multiple pricing indicator code provide information on how the service or supply is priced by Medicare or other insurers. Healthcare providers should verify coverage and reimbursement rates with the payer before performing the procedure.

8. Examples

Here are five examples of when HCPCS code A9587 should be billed:

1. A patient with a suspected neuroendocrine tumor undergoes a diagnostic imaging procedure using Gallium ga-68, dotatate.
2. A physician orders a PET scan with Gallium ga-68, dotatate to evaluate the effectiveness of a treatment for a known neuroendocrine tumor.
3. A patient with a history of neuroendocrine tumor undergoes routine surveillance imaging using Gallium ga-68, dotatate.
4. A healthcare provider performs a diagnostic imaging procedure using Gallium ga-68, dotatate to assess the extent of a known neuroendocrine tumor.
5. A patient with symptoms suggestive of a neuroendocrine tumor undergoes a diagnostic workup, including a PET scan with Gallium ga-68, dotatate.