How To Use HCPCS Code C9459

HCPCS code C9459 describes the diagnostic use of Flutemetamol F18, a radioactive substance used in imaging studies. This code is specific to the per study dose of Flutemetamol F18, with a maximum dosage of up to 5 millicuries. In this article, we will explore the details of HCPCS code C9459, including its official description, procedure, usage guidelines, billing requirements, historical information, and coverage by Medicare and other insurance providers.

1. What is HCPCS C9459?

HCPCS code C9459 is used to identify the diagnostic use of Flutemetamol F18, a radiopharmaceutical agent used in imaging studies. This code specifically refers to the per study dose of Flutemetamol F18, with a maximum dosage of up to 5 millicuries. It is important to note that this code is specific to the dosage and administration of Flutemetamol F18 and should not be used for other radiopharmaceutical agents or imaging procedures.

2. Official Description

The official description of HCPCS code C9459 is “Flutemetamol F18, diagnostic, per study dose, up to 5 millicuries.” This description accurately reflects the purpose and dosage limitations of this code. The short description for this code is “Enteral supp not otherwise c,” which indicates that this code is not applicable to enteral supplementation services.

3. Procedure

1. The procedure for HCPCS code C9459 involves the administration of Flutemetamol F18 to the patient for diagnostic imaging purposes.
2. The healthcare provider prepares the Flutemetamol F18 solution according to the manufacturer’s instructions.
3. The provider then administers the Flutemetamol F18 solution to the patient via the appropriate route, such as intravenous injection.
4. After the administration, the patient undergoes the imaging study, such as a positron emission tomography (PET) scan, to visualize the targeted area.
5. The healthcare provider interprets the imaging results to aid in the diagnosis and treatment planning for the patient.

4. When to use HCPCS code C9459

HCPCS code C9459 should be used when a healthcare provider administers Flutemetamol F18 for diagnostic imaging purposes. This code is specifically for the per study dose of Flutemetamol F18, with a maximum dosage of up to 5 millicuries. It is important to ensure that the usage of this code aligns with the specific guidelines and eligibility criteria set by the payer or insurance provider.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9459, healthcare providers need to ensure proper documentation of the administration of Flutemetamol F18 and the associated imaging study. This documentation should include details such as the dosage administered, the route of administration, the date of service, and the medical necessity for the procedure. Additionally, providers should follow the billing guidelines and requirements set by the payer or insurance provider to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9459 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. As of June 30, 2016, this code has been terminated. The termination of this code indicates that it is no longer actively used for billing purposes. It is important for medical coders and billers to stay updated on code changes and terminations to ensure accurate coding and billing practices.

7. Medicare and Insurance Coverage

HCPCS code C9459 may be covered by Medicare and other insurance providers, subject to their specific coverage policies and guidelines. The pricing indicator code for this code 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. It is essential for healthcare providers to verify the coverage and reimbursement policies of each payer to ensure proper billing and reimbursement for the use of HCPCS code C9459.

8. Examples

Here are some examples of scenarios where HCPCS code C9459 may be billed:

1. A patient presents with suspected Alzheimer’s disease, and the healthcare provider administers Flutemetamol F18 for a PET scan to aid in the diagnosis.
2. A patient with a history of cancer undergoes a follow-up imaging study using Flutemetamol F18 to monitor the response to treatment.
3. A patient with suspected cardiac abnormalities undergoes a cardiac PET scan using Flutemetamol F18 to assess myocardial perfusion.
4. A patient with suspected neurodegenerative disorder undergoes a brain imaging study using Flutemetamol F18 to detect amyloid plaques.
5. A patient with suspected infection undergoes a whole-body imaging study using Flutemetamol F18 to identify the source of infection.