How To Use HCPCS Code A9599

HCPCS code A9599 describes a radiopharmaceutical used for beta-amyloid positron emission tomography (PET) imaging. This code is specifically used to identify the diagnostic radiology procedure involving the administration of a radiopharmaceutical for the purpose of imaging beta-amyloid plaques in the brain. In this article, we will explore the details of HCPCS code A9599, 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 A9599?

HCPCS code A9599 is a specific code used to identify the radiopharmaceutical, diagnostic, for beta-amyloid PET imaging, per study dose, not otherwise specified. It is important to note that this code is used exclusively for the purpose of beta-amyloid PET imaging and should not be used for any other diagnostic procedures or radiopharmaceuticals.

2. Official Description

The official description of HCPCS code A9599 is “Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (PET) imaging, per study dose, not otherwise specified.” This description accurately reflects the purpose and usage of this code.

3. Procedure

1. The procedure involving HCPCS code A9599 begins with the administration of the radiopharmaceutical to the patient.
2. The patient is then positioned in the PET scanner, and the imaging process begins.
3. The scanner detects the radioactive signals emitted by the radiopharmaceutical and creates detailed images of the beta-amyloid plaques in the brain.
4. These images are then analyzed by a radiologist or nuclear medicine physician to aid in the diagnosis and management of conditions such as Alzheimer’s disease.

4. When to use HCPCS code A9599

HCPCS code A9599 should be used when performing beta-amyloid PET imaging for diagnostic purposes. It is typically used in cases where there is a clinical suspicion of Alzheimer’s disease or other neurodegenerative disorders characterized by the presence of beta-amyloid plaques in the brain. It is important to follow any specific eligibility criteria or guidelines provided by payers or regulatory bodies when using this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9599, healthcare providers need to ensure that the following documentation is included:

• Documentation supporting the medical necessity of the beta-amyloid PET imaging procedure
• Documentation of the radiopharmaceutical used, including the name, dosage, and administration details
• Documentation of the interpretation and analysis of the imaging results

Providers should also follow the specific billing guidelines provided by payers to ensure accurate and timely reimbursement for the service.

6. Historical Information and Code Maintenance

HCPCS code A9599 was added to the Healthcare Common Procedure Coding System on January 01, 2014. It has an effective date of January 01, 2018. As of December 31, 2017, this code was terminated and is no longer in use. No maintenance actions have been taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code A9599 is classified as a special coverage code, denoted by the coverage code D. This means that special coverage instructions may apply when billing for this code. The pricing indicator code for A9599 is 57, which indicates 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.

Medicare and other insurance providers may have specific coverage policies and reimbursement rates for HCPCS code A9599. It is important for healthcare providers to verify the coverage and reimbursement guidelines with the respective payers to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code A9599 should be billed:

1. A patient presents with memory loss and cognitive decline, and a beta-amyloid PET scan is ordered to evaluate for the presence of beta-amyloid plaques in the brain.
2. A patient with a family history of Alzheimer’s disease undergoes a beta-amyloid PET scan as part of a research study on early detection of the disease.
3. A patient with atypical symptoms of dementia undergoes a beta-amyloid PET scan to aid in the differential diagnosis of various neurodegenerative disorders.
4. A patient with mild cognitive impairment undergoes a beta-amyloid PET scan to assess the risk of progression to Alzheimer’s disease.
5. A patient with a known diagnosis of Alzheimer’s disease undergoes a beta-amyloid PET scan to monitor the progression of the disease and evaluate the response to treatment.