How To Use HCPCS Code A9593

HCPCS code A9593 describes the diagnostic use of Gallium Ga-68 PSMA-11, specifically provided by UCSF, in the field of radiology. This code is used to identify and bill for the administration of this diagnostic radiopharmaceutical.

1. What is HCPCS A9593?

HCPCS code A9593 is a specific code used in medical billing and coding to identify the diagnostic use of Gallium Ga-68 PSMA-11. This code is specifically associated with the UCSF (University of California, San Francisco) provider. It is important to note that HCPCS codes are used to standardize the reporting of medical procedures, services, and supplies for reimbursement purposes.

2. Official Description

The official description of HCPCS code A9593 is “Gallium Ga-68 PSMA-11, diagnostic, (UCSF), 1 millicurie”. The short description of this code is “Gallium Ga-68 PSMA-11 UCSF”. These descriptions accurately represent the specific diagnostic radiopharmaceutical and the provider associated with it.

3. Procedure

1. The procedure associated with HCPCS code A9593 involves the administration of Gallium Ga-68 PSMA-11 for diagnostic purposes. The radiopharmaceutical is typically injected into the patient’s bloodstream.
2. Once administered, the Gallium Ga-68 PSMA-11 is allowed to circulate throughout the body.
3. During this circulation, the radiopharmaceutical binds to prostate-specific membrane antigen (PSMA) present in prostate cancer cells.
4. After a sufficient amount of time has passed to allow for proper distribution and binding, the patient undergoes imaging using a positron emission tomography (PET) scanner.
5. The PET scan captures images of the areas where the Gallium Ga-68 PSMA-11 has accumulated, providing valuable diagnostic information about the presence and extent of prostate cancer.

4. When to use HCPCS code A9593

HCPCS code A9593 should be used when a healthcare provider administers Gallium Ga-68 PSMA-11 for diagnostic purposes, specifically when the service is provided by UCSF. This code is applicable for patients undergoing PET imaging to evaluate prostate cancer.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9593, healthcare providers should ensure that the following documentation is included:

• Medical records indicating the medical necessity for the diagnostic procedure
• Documentation of the administration of Gallium Ga-68 PSMA-11
• Imaging reports or results from the PET scan

It is important to follow the specific billing guidelines and requirements of the insurance payer or Medicare to ensure proper reimbursement for the service.

6. Historical Information and Code Maintenance

HCPCS code A9593 was added to the Healthcare Common Procedure Coding System on July 01, 2021. As of October 01, 2021, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This suggests that the code has remained unchanged since its addition.

7. Medicare and Insurance Coverage

The coverage and pricing of HCPCS code A9593 may vary depending on the insurance payer or Medicare. The pricing indicator code 57 indicates that the code is priced by other carriers. The multiple pricing indicator code A suggests that the code is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of when HCPCS code A9593 should be billed:

1. A patient with a history of prostate cancer undergoes a PET scan using Gallium Ga-68 PSMA-11 at UCSF for diagnostic evaluation.
2. A physician orders a PET scan with Gallium Ga-68 PSMA-11 for a patient suspected of having recurrent prostate cancer, and the service is provided by UCSF.
3. A patient with an elevated prostate-specific antigen (PSA) level undergoes a PET scan using Gallium Ga-68 PSMA-11 at UCSF to determine the presence and extent of prostate cancer.
4. A patient with a known diagnosis of prostate cancer undergoes a follow-up PET scan using Gallium Ga-68 PSMA-11 at UCSF to assess treatment response.
5. A patient with a rising PSA level after prostate cancer treatment undergoes a PET scan using Gallium Ga-68 PSMA-11 at UCSF to identify potential sites of recurrent disease.