How To Use HCPCS Code C9156

HCPCS code C9156 describes the diagnostic use of Flotufolastat F 18, a radiopharmaceutical agent used in imaging procedures. This code is specifically used for the administration of 1 millicurie of Flotufolastat F 18 for diagnostic purposes. In this article, we will explore the details of HCPCS code C9156, 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 C9156?

HCPCS code C9156 is a specific code used to identify the diagnostic use of Flotufolastat F 18. It is important to note that this code is only applicable for the administration of 1 millicurie of Flotufolastat F 18 for diagnostic purposes.

2. Official Description

The official description of HCPCS code C9156 is “Flotufolastat F 18, diagnostic, 1 millicurie.” This description accurately reflects the purpose and dosage of the radiopharmaceutical agent.

3. Procedure

1. The procedure for HCPCS code C9156 involves the administration of Flotufolastat F 18, a radiopharmaceutical agent, to the patient.
2. The dosage administered should be 1 millicurie of Flotufolastat F 18.
3. The administration of Flotufolastat F 18 is performed for diagnostic purposes, typically in imaging procedures.
4. It is important for the healthcare provider to follow the appropriate safety protocols and guidelines for handling and administering radiopharmaceutical agents.

4. When to use HCPCS code C9156

HCPCS code C9156 should be used when a healthcare provider administers 1 millicurie of Flotufolastat F 18 for diagnostic purposes. This code is specifically for the diagnostic use of Flotufolastat F 18 and should not be used for any other purposes or dosages.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9156, healthcare providers should ensure that the following guidelines and documentation requirements are met:

• Accurately report the dosage administered as 1 millicurie of Flotufolastat F 18.
• Include appropriate documentation supporting the diagnostic use of Flotufolastat F 18.
• Follow any specific billing guidelines or requirements set forth by Medicare or other insurance providers.

6. Historical Information and Code Maintenance

HCPCS code C9156 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. As of December 31, 2023, this code has been terminated. The termination of this code means that it is no longer valid for use in billing or reporting purposes after the specified date.

7. Medicare and Insurance Coverage

HCPCS code C9156 falls under the coverage code D, which indicates that special coverage instructions apply. The pricing indicator code for this code is 57, which signifies 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. Healthcare providers should consult the Medicare Carriers Manual Reference Section Number 2130 for further guidance on coverage and reimbursement for HCPCS code C9156.

8. Examples

Here are some examples of scenarios where HCPCS code C9156 should be billed:

1. A patient undergoes a PET scan for the diagnosis and staging of prostate cancer. During the procedure, 1 millicurie of Flotufolastat F 18 is administered for imaging purposes. HCPCS code C9156 should be used to bill for the diagnostic use of Flotufolastat F 18.
2. A patient with suspected neuroendocrine tumors undergoes a diagnostic imaging procedure using Flotufolastat F 18. The healthcare provider administers 1 millicurie of Flotufolastat F 18 for accurate imaging and diagnosis. HCPCS code C9156 should be used to bill for this specific diagnostic use.
3. A patient is scheduled for a cardiac PET scan to assess myocardial viability. During the procedure, 1 millicurie of Flotufolastat F 18 is administered for diagnostic imaging. HCPCS code C9156 should be used to bill for the administration of Flotufolastat F 18 in this scenario.
4. A healthcare provider performs a diagnostic imaging procedure to evaluate suspected lung cancer in a patient. 1 millicurie of Flotufolastat F 18 is administered for accurate imaging and diagnosis. HCPCS code C9156 should be used to bill for the diagnostic use of Flotufolastat F 18 in this case.
5. A patient undergoes a diagnostic imaging procedure to assess the extent of bone metastases. During the procedure, 1 millicurie of Flotufolastat F 18 is administered for accurate imaging and diagnosis. HCPCS code C9156 should be used to bill for the administration of Flotufolastat F 18 in this scenario.