How To Use HCPCS Code C9458

HCPCS code C9458 describes the diagnostic use of Florbetaben F18, administered as a study dose of up to 8.1 millicuries. This code is used to identify the specific procedure and ensure accurate billing and reimbursement for healthcare providers.

1. What is HCPCS C9458?

HCPCS code C9458 is a specific alphanumeric code used in medical coding to identify a particular healthcare service or supply. In this case, it represents the diagnostic use of Florbetaben F18, a radiopharmaceutical agent used in positron emission tomography (PET) imaging to detect beta-amyloid plaques in the brain. This procedure helps in the evaluation of patients suspected of having Alzheimer’s disease or other causes of cognitive decline.

2. Official Description

The official description of HCPCS code C9458 is “Florbetaben F18, diagnostic, per study dose, up to 8.1 millicuries.” This description accurately reflects the specific use and dosage of Florbetaben F18 for diagnostic purposes. The short description for this code is “Parenteral supp not othrws c,” indicating that it is a parenteral supply not otherwise classified.

3. Procedure

1. The procedure involving HCPCS code C9458 begins with the preparation of the patient for the PET imaging study.
2. The healthcare provider administers Florbetaben F18 intravenously, ensuring the accurate dosage of up to 8.1 millicuries.
3. After the administration, the patient undergoes PET imaging, where the radiopharmaceutical agent binds to beta-amyloid plaques in the brain.
4. The PET scan captures images of the brain, allowing the healthcare provider to evaluate the presence and distribution of beta-amyloid plaques.
5. The images obtained from the PET scan are then interpreted by a qualified physician or radiologist to make a diagnosis or assess the progression of Alzheimer’s disease or other cognitive disorders.

4. When to use HCPCS code C9458

HCPCS code C9458 should be used when healthcare providers perform a diagnostic study using Florbetaben F18 to evaluate patients suspected of having Alzheimer’s disease or other causes of cognitive decline. It is important to ensure that the patient meets the specific eligibility criteria for this procedure, as determined by the healthcare provider and any applicable guidelines or coverage instructions.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9458, healthcare providers need to document the administration of Florbetaben F18, including the dosage administered and any relevant details regarding the patient’s condition or symptoms. It is crucial to maintain accurate and detailed documentation to support the medical necessity of the procedure and ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9458 was added to the Healthcare Common Procedure Coding System on January 1, 1985. It has an effective date of January 1, 1996, and was terminated on June 30, 2016. This code has no maintenance actions associated with it, as indicated by the action code N, which means no maintenance for this code. The termination of this code suggests that there may be alternative codes or procedures available for the diagnostic evaluation of Alzheimer’s disease or cognitive decline.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may have specific coverage instructions and pricing indicators for HCPCS code C9458. The pricing indicator code 57 indicates that the code is priced by other carriers, and the multiple pricing indicator code A signifies 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 this procedure.

8. Examples

Here are five examples of scenarios where HCPCS code C9458 may be billed:

1. A 65-year-old patient presents with memory loss and cognitive decline. The healthcare provider performs a PET scan using Florbetaben F18 to evaluate the presence of beta-amyloid plaques in the brain.
2. A 70-year-old patient with a family history of Alzheimer’s disease undergoes a diagnostic study using Florbetaben F18 to assess their risk of developing the condition.
3. A 55-year-old patient experiences cognitive impairment, and the healthcare provider orders a PET scan with Florbetaben F18 to determine the underlying cause.
4. A 75-year-old patient with suspected Alzheimer’s disease undergoes a follow-up PET scan using Florbetaben F18 to monitor the progression of the disease.
5. A 60-year-old patient with cognitive decline and a history of head trauma receives a PET scan with Florbetaben F18 to evaluate the presence of beta-amyloid plaques as a potential cause of their symptoms.