How To Use HCPCS Code A9594

HCPCS code A9594 describes the diagnostic use of Gallium Ga-68 PSMA-11 at UCLA. This article will provide an in-depth understanding of this specific code, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and examples of when to bill for this code.

1. What is HCPCS A9594?

HCPCS code A9594 is used to identify the diagnostic use of Gallium Ga-68 PSMA-11 at UCLA. This specific code is used to indicate the administration of this radiopharmaceutical for diagnostic purposes. It is important to note that HCPCS codes are used for billing and reporting purposes in the healthcare industry.

2. Official Description

The official description of HCPCS code A9594 is “Gallium Ga-68 PSMA-11, diagnostic, (UCLA), 1 millicurie.” The short description provided for this code is “Gallium Ga-68 PSMA-11, UCLA.” These descriptions accurately represent the specific diagnostic radiopharmaceutical and the institution where it is administered.

3. Procedure

1. The procedure for HCPCS code A9594 involves the administration of Gallium Ga-68 PSMA-11 for diagnostic purposes. The radiopharmaceutical is typically injected into the patient’s body, allowing it to be absorbed by specific tissues or organs. The Gallium Ga-68 PSMA-11 then emits radiation, which can be detected by imaging equipment such as a PET scanner.
2. During the procedure, the patient may be required to follow certain preparation instructions, such as fasting or avoiding certain medications. The healthcare provider will ensure that the patient is positioned correctly for the imaging process.
3. Once the Gallium Ga-68 PSMA-11 is administered, the imaging equipment will capture the emitted radiation, producing detailed images of the targeted tissues or organs. These images can help in the diagnosis and evaluation of certain conditions, such as prostate cancer.
4. After the procedure, the healthcare provider will analyze the images and provide a report to the referring physician, who will then use the information to guide further treatment decisions.

4. When to use HCPCS code A9594

HCPCS code A9594 should be used when the diagnostic procedure involving Gallium Ga-68 PSMA-11 is performed at UCLA. It is important to ensure that the specific radiopharmaceutical and institution match the official description provided for this code. The use of this code is typically determined by carrier judgment, meaning that the healthcare provider or insurance carrier will assess the appropriateness of using this code based on the specific circumstances of the patient’s case.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9594, healthcare providers need to ensure that the necessary documentation is in place. This may include the patient’s medical records, the order for the diagnostic procedure, and any relevant imaging reports. It is important to accurately report the dosage of Gallium Ga-68 PSMA-11 administered and the specific institution where the procedure took place. Following the appropriate billing guidelines and providing complete documentation will help ensure accurate reimbursement for the service.

6. Historical Information and Code Maintenance

HCPCS code A9594 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 code is priced by other carriers, as indicated by the pricing indicator code 57. The multiple pricing indicator code A signifies that this code is not applicable for multiple pricing methodologies.

7. Medicare and Insurance Coverage

Medicare and other insurance carriers may provide coverage for HCPCS code A9594, subject to their specific policies and guidelines. The pricing of this service by Medicare or other insurers will depend on the pricing indicator code assigned to this code. It is important for healthcare providers to verify coverage and reimbursement policies with the respective payers to ensure appropriate billing and reimbursement for the diagnostic procedure.

8. Examples

Here are five examples of scenarios where HCPCS code A9594 may be billed:

1. A patient with suspected prostate cancer undergoes a diagnostic procedure using Gallium Ga-68 PSMA-11 at UCLA.
2. A patient with a history of prostate cancer undergoes a follow-up diagnostic procedure using Gallium Ga-68 PSMA-11 at UCLA to assess the effectiveness of treatment.
3. A patient with recurrent prostate cancer undergoes a diagnostic procedure using Gallium Ga-68 PSMA-11 at UCLA to determine the extent of disease spread.
4. A patient with rising prostate-specific antigen (PSA) levels undergoes a diagnostic procedure using Gallium Ga-68 PSMA-11 at UCLA to detect potential cancer recurrence.
5. A patient with suspected metastatic prostate cancer undergoes a diagnostic procedure using Gallium Ga-68 PSMA-11 at UCLA to identify the presence and location of metastases.