How To Use HCPCS Code A9592

HCPCS code A9592 describes the use of Copper cu-64 dotatate for diagnostic purposes. This code is used to identify the specific radiopharmaceutical agent and the quantity used in the diagnostic procedure. In this article, we will explore the details of HCPCS code A9592, 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 A9592?

HCPCS code A9592 is used to identify Copper cu-64 dotatate, a radiopharmaceutical agent used for diagnostic purposes. This code specifically refers to the diagnostic use of Copper cu-64 dotatate and the quantity administered during the procedure.

2. Official Description

The official description of HCPCS code A9592 is “Copper cu-64, dotatate, diagnostic, 1 millicurie.” The short description is “Copper cu 64 dotatate diag.”

3. Procedure

1. The procedure for HCPCS code A9592 involves the administration of Copper cu-64 dotatate to the patient.
2. The radiopharmaceutical agent is typically injected into the patient’s bloodstream.
3. Once administered, the Copper cu-64 dotatate travels to specific receptors in the body, allowing for the visualization and diagnosis of certain conditions or diseases.
4. The procedure may involve imaging techniques such as positron emission tomography (PET) scans or single-photon emission computed tomography (SPECT) scans.
5. The quantity of Copper cu-64 dotatate administered is 1 millicurie.

4. When to use HCPCS code A9592

HCPCS code A9592 should be used when Copper cu-64 dotatate is utilized for diagnostic purposes. This code is specific to the use of Copper cu-64 dotatate and should not be used for other radiopharmaceutical agents or diagnostic procedures.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9592, healthcare providers need to document the administration of Copper cu-64 dotatate for diagnostic purposes. This documentation should include the quantity administered, the specific diagnostic procedure performed, and any relevant findings or observations.

6. Historical Information and Code Maintenance

HCPCS code A9592 was added to the Healthcare Common Procedure Coding System on April 01, 2021. As of January 01, 2024, there will be a payment change associated with this code. The pricing indicator code for A9592 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.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code A9592 may vary. It is important to check with individual payers to determine coverage and reimbursement policies. 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 when HCPCS code A9592 should be billed:

1. A patient undergoes a PET scan using Copper cu-64 dotatate for the diagnosis and staging of neuroendocrine tumors.
2. A physician orders a SPECT scan with Copper cu-64 dotatate to evaluate the presence and extent of somatostatin receptor-positive tumors.
3. A patient with a history of carcinoid tumor undergoes a diagnostic imaging procedure using Copper cu-64 dotatate to assess disease progression.
4. A healthcare provider performs a diagnostic scan using Copper cu-64 dotatate to detect and localize neuroendocrine tumors in a patient.
5. A physician orders a Copper cu-64 dotatate scan to evaluate the response to treatment in a patient with known neuroendocrine tumors.