How To Use HCPCS Code A9595

HCPCS code A9595 describes the diagnostic procedure for piflufolastat f-18, which involves the use of a radioactive substance to aid in the detection and diagnosis of certain medical conditions. This code is used to identify the administration of piflufolastat f-18 in a dosage of 1 millicurie. In this article, we will explore the details of HCPCS code A9595, including its official description, procedure, usage guidelines, billing requirements, historical information, and coverage by Medicare and other insurance providers.

1. What is HCPCS A9595?

HCPCS code A9595 is a specific code used to identify the diagnostic procedure involving the administration of piflufolastat f-18 in a dosage of 1 millicurie. It is important to note that this code is only applicable for diagnostic purposes and not for therapeutic treatments. Healthcare providers use this code to accurately document and bill for the use of piflufolastat f-18 in their medical services.

2. Official Description

The official description of HCPCS code A9595 is “Piflufolastat f-18, diagnostic, 1 millicurie.” The short description for this code is “Piflu f-18, dia 1 millicurie.” These descriptions provide a concise summary of the procedure and the dosage involved.

3. Procedure

1. The procedure for HCPCS code A9595 involves the administration of piflufolastat f-18, a radioactive substance, to the patient.
2. The healthcare provider prepares the dosage of piflufolastat f-18 in a 1 millicurie quantity.
3. The prepared dosage is then administered to the patient through a suitable route, such as intravenous injection or oral ingestion, depending on the specific diagnostic requirements.
4. Once administered, the piflufolastat f-18 travels through the patient’s body and emits radiation, which can be detected and captured by imaging devices.
5. The imaging devices, such as PET scanners, capture the emitted radiation and generate detailed images of the patient’s internal organs or tissues.
6. These images are then analyzed by healthcare professionals to aid in the diagnosis and evaluation of certain medical conditions.

4. When to use HCPCS code A9595

HCPCS code A9595 should be used when healthcare providers perform the diagnostic procedure involving the administration of piflufolastat f-18 in a dosage of 1 millicurie. This code is used to accurately identify and document the use of piflufolastat f-18 for diagnostic purposes. It is important to ensure that the specific dosage and procedure match the requirements outlined in the code description.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9595, healthcare providers need to ensure proper documentation of the procedure and dosage administered. This includes documenting the specific dosage of piflufolastat f-18 used (1 millicurie) and the route of administration. Additionally, providers should include any relevant medical records, imaging reports, and supporting documentation to substantiate the medical necessity of the procedure.

6. Historical Information and Code Maintenance

HCPCS code A9595 was added to the Healthcare Common Procedure Coding System on January 01, 2022. As of its addition, 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 relatively new and does not have a significant historical context or changes since its addition.

7. Medicare and Insurance Coverage

The coverage and pricing of HCPCS code A9595 may vary depending on the specific policies of Medicare and other insurance providers. The pricing indicator code for this code is 57, which indicates that it is priced by carriers using other methodologies. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology. Healthcare providers should consult the Medicare and insurance coverage guidelines to determine the reimbursement rates and coverage criteria for this specific procedure.

8. Examples

Here are five examples of scenarios where HCPCS code A9595 may be billed:

1. A patient undergoes a PET scan with the administration of piflufolastat f-18 in a dosage of 1 millicurie to evaluate the extent of a suspected tumor.
2. A physician orders a diagnostic procedure involving the use of piflufolastat f-18 in a dosage of 1 millicurie to assess the presence of metastatic cancer in a patient.
3. A healthcare provider performs a diagnostic imaging study using piflufolastat f-18 in a dosage of 1 millicurie to evaluate the perfusion of blood in a patient’s heart.
4. A patient with a history of neurological disorders undergoes a diagnostic procedure involving the administration of piflufolastat f-18 in a dosage of 1 millicurie to assess brain function and detect any abnormalities.
5. A physician orders a diagnostic scan with the use of piflufolastat f-18 in a dosage of 1 millicurie to evaluate the response of a patient’s lymph nodes to a specific treatment.