How To Use HCPCS Code A9588

HCPCS code A9588 describes the diagnostic radiology procedure for Fluciclovine F-18. This code is used to identify the administration of Fluciclovine F-18, a radioactive diagnostic agent, for imaging purposes. In this article, we will explore the details of HCPCS code A9588, 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 A9588?

HCPCS code A9588 is used to identify the diagnostic radiology procedure involving the administration of Fluciclovine F-18. Fluciclovine F-18 is a radioactive diagnostic agent that is used in positron emission tomography (PET) imaging to detect and localize prostate cancer recurrence. This code specifically represents the administration of 1 millicurie of Fluciclovine F-18.

2. Official Description

The official description of HCPCS code A9588 is “Fluciclovine F-18, diagnostic, 1 millicurie.” This description accurately reflects the purpose and quantity of the procedure.

3. Procedure

1. The procedure for HCPCS code A9588 involves the administration of Fluciclovine F-18 to the patient.
2. The healthcare provider prepares the Fluciclovine F-18 solution according to the manufacturer’s instructions.
3. The prepared solution is then injected into the patient intravenously.
4. After the administration, the patient undergoes PET imaging to visualize the distribution of Fluciclovine F-18 in the body.
5. The imaging results are interpreted by a radiologist or other qualified healthcare professional.

4. When to use HCPCS code A9588

HCPCS code A9588 should be used when a healthcare provider administers Fluciclovine F-18 for diagnostic purposes. This procedure is typically performed in patients with a history of prostate cancer who are suspected of having a recurrence. It is important to note that the use of this code is subject to carrier judgment, meaning that the healthcare provider should consult with the insurance carrier to determine coverage and reimbursement.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9588, healthcare providers should ensure that the following documentation requirements are met:

• Medical necessity for the procedure should be clearly documented in the patient’s medical record.
• The dosage and administration details, including the quantity of Fluciclovine F-18 administered (1 millicurie), should be documented.
• The date of service and the healthcare provider’s identification information should be included on the claim.

6. Historical Information and Code Maintenance

HCPCS code A9588 was added to the Healthcare Common Procedure Coding System on January 01, 2017. As of January 01, 2024, this code has a carrier judgment coverage code and a payment change action code. The pricing indicator code for this code is 57, indicating 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 since its addition.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code A9588 may vary. It is important for healthcare providers to verify coverage and reimbursement policies with the respective payers. The pricing indicator code and multiple pricing indicator code provide information on how the service or supply is priced by Medicare or other insurers.

8. Examples

Here are five examples of scenarios in which HCPCS code A9588 should be billed:

1. A patient with a history of prostate cancer undergoes Fluciclovine F-18 PET imaging to detect and localize a suspected recurrence.
2. A healthcare provider administers Fluciclovine F-18 to a patient as part of a clinical trial investigating its efficacy in prostate cancer imaging.
3. A patient with rising prostate-specific antigen (PSA) levels undergoes Fluciclovine F-18 PET imaging to assess the presence of recurrent disease.
4. A healthcare provider administers Fluciclovine F-18 to a patient prior to prostate cancer surgery to aid in surgical planning.
5. A patient with a suspected prostate cancer recurrence undergoes Fluciclovine F-18 PET imaging to guide targeted biopsy.