radiopharmaceutical therapy by intravenous administration cpt code

Radiopharmaceuticals HCPCS & CPT Codes – List & Guidelines (2022)

Radiopharmaceuticals are used in the field of nuclear medicine as tracers in the diagnosis and treatment of many diseases.

Many radiopharmaceuticals use technetium-99m (Tc-99m) which has many useful properties as a gamma-emitting tracer nuclide.

In the book Technetium a total of 31 different radiopharmaceuticals based on Tc-99m are listed for imaging and functional studies of the brain, myocardium, thyroid, lungs, liver, gallbladder, kidneys, skeleton, blood and tumors.

When radiopharmaceuticals are injected into the body, they emit a radioactive signal which can be traced with special cameras or computers.

The amount of radiation a patient is subjected to is about the same as a normal x-ray, but the information gathered is significantly different.

Coders should check the radiopharmaceuticals current HCPCS code description carefully. The codes description defines one unit of service.

The following examples include radiopharmaceutical therapy by intravenous administration cpt code.

Coding For Radiopharmaceuticals Agents

Most radiopharmaceuticals that have their own code include in the code’s description “per study dose” and include a range of mCi’s (millicurie).

These radiopharmaceutical agents should be billed as one unit of service per study. It is not appropriate to bill per mCi for the codes that include per study dose in its HCPC’s description.

It would be unusual to have more than 2 units of service for most of the agents with a per study dose or per treatment in its description.

Example: A9503 is defined as Technetium Tc 99m, Medronate, (MDP), diagnostic, per study dose, up to 30 mCi’s).

Per study dose, up to 30 millicuries is one unit of service. If the provider administers one to 30mCi of this agent for a study, it should be billed as one unit of service.

Some radiopharmaceutical code descriptions are defined as per millicurie (mCi). These agents should be billed per millicurie.

The number of mCi’s that were administered to the patient should be the same as the number of services listed in the unit field on the claim.

Example: A9512 is defined as Technetium Tc-99m-Pertechnetate, Diagnostic, per mCi. If you administer 5 mCi of this agent to your patient then 5 would be listed in the units’ field of the claim.

NOC radiopharmaceutical codes (A4641, A9699) should be billed with one unit of service. The claim must include the name and total dosage of the agent in item 19 of the CMS 1500 form, or the electronic equivalent for EMC.

The following radiopharmaceuticals will be considered medically necessary when used with the procedures listed below.

CPT Codes For Technetium (Tc) Labeled Radiopharmaceutical

HCPCS Code A9557

Description Of A9557: Technetium Tc-99m Bicisate (Neurolite®), Diagnostic, per study dose, up to 25 mCi’s.

CPT Codes For A9557

CPT 78600 – CPT 78607, CPT 78610: Brain imaging.

HCPCS Code A9551

Description Of A9551: Technetium Tc-99m Succimer (DMSA), Diagnostic, per study dose, up to 10 mCi’s.

CPT Codes For A9551

CPT-4 Codes, CPT 78700 – CPT 78710: Parenchymal renal scan.

CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Tumor detection.

HCPCS Code A9539

Description Of A9539: Technetium Tc-99m Pentetate, Diagnostic, per study dose, up to 25 mCi’s.

CPT Codes For A9539

CPT 78579, CPT 78580, CPT 78582, CPT 78597, CPT 78598: Lung ventilation.

CPT 78761: Testicular imaging with vascular flow.

CPT 78700 – CPT 78725: GFR renal scan.

CPT 78730: Urinary bladder residual.

CPT 78740: Ureteral reflux.

CPT 78630 – CPT 78650: CSF study.

CPT 78600 – CPT 78607, CPT 78610: Brain study.

CPT 78291, CPT 78645: Shunt patency agent. 500 uCi

CPT 78481, CPT 78483: First-pass cardiac technique studies.

CPT 78445: Vascular flow study.

CPT 78428: Cardiac Shunt detection

HCPCS Code A9567

Description Of A9567: Technetium Tc-99m Pentetate, Diagnostic, aerosol, per study dose, up to 75 mCi’s.

CPT Codes For A9567

CPT 78579, CPT 78580, CPT 78582, CPT 78597, CPT 78598: Lung ventilation.

HCPCS Code A9510

Description Of A9510: Technetium Tc-99m Disofenin (Hepatolite, DISIDA), per study dose, up to 15 mCi’s.

CPT Codes For A9510

CPT 78226 & CPT 78227: Hepatobiliary scan agent.

HCPCS Code A9521

Description Of A9521: Technetium Tc-99m Exametazine (Ceretec®), Diagnostic, per study dose, up to 25 mCi’s.

CPT Codes For A9521

CPT 78600 – CPT 78607, CPT 78610: Brain perfusion.

HCPCS Code A9569

Description Of A9569: Technetium TC-99m Exametazime labeled autologous white blood cells, Diagnostic, per study dose.

CPT Codes For A9569

CPT 78805, CPT 78806, CPT 78807: Infection detection

HCPCS Code A4641

Description Of A4641: TechnetiumTc-99m Human Serum Albumin Usual Dosage 2-20 mCi.

CPT Codes For A4641

CPT 78630 – CPT 78652: CSF Leak Study.

CPT 78414 – CPT 78458: Blood pool agent.

CPT 78195: Lymphatic imaging.

HCPCS Code A9540

Description Of A9540: Technetium Tc-99m Macroaggregated Albumin (MAA), Diagnostic, per study dose, up to 10 mCi’s.

CPT Codes For A9540

CPT 78580, CPT 78582, CPT 78597, CPT 78598: Lung perfusion agent.

CPT 78291: Peritoneal-Venous Shunt Study.

CPT 78800, CPT 78801, CPT 78803: Peritoneal cavity imaging prior to intraperitoneal chemotherapy.

CPT 78216, CPT 78428: Cardiac Shunt Detection.

CPT 78201, CPT 78205, CPT 78215: Liver imaging (SPECT).

HCPCS Code A9537

Description Of A9537: Technetium Tc-99m Mebrofenin (Choletec) Diagnostic, per study dose, up to 15 mCi’s.

CPT Codes For A9537

CPT 78226, CPT 78227: Hepatobiliary scan agent.

HCPCS Code A9562

Description Of A9562: Technetium Tc-99m Mertiatide (MAG-3), diagnostic, per study dose, up to 15 mCi’s.

CPT Codes For A9562

CPT 78700 – CPT 78725: Renal scan agent.

HCPCS Code A9503

Description Of A9503: Technetium Tc 99m, Medronate, (MDP), diagnostic, per study dose, up to 30 mCi’s.

CPT Codes For A9503

CPT 78300 – CPT 78320, CPT 78399: Bone scan.

HCPCS Code A9561

Description Of A9561: Technetium Tc-99m Oxidronate, Diagnostic, per study dose, up to 30 mCi’s.

CPT Codes For A9561

CPT 78300 – CPT 78320, CPT 78399: Bone scan agent.

HCPCS Code A9512

Description Of A9512: Technetium Tc-99m-Pertechnetate, Diagnostic, per mCi.

CPT Codes For A9512

CPT 78000, CPT 78001, CPT 78006, CPT 78007, CPT 78010, CPT 78011, CPT 78015: Thyroid study.

CPT 78600, CPT 78601, CPT 78602, CPT 78603, CPT 78604, CPT 78605, CPT 78606, CPT 78607, CPT 78610: Brain death.

CPT 78481, CPT 78483: First-pass cardiac technique studies.

CPT-4 Codes, CPT 78261, CPT 78290: Meckel’s diverticulum 10-20 mCi.

CPT 78070: Parathyroid study.

CPT 78230, CPT 78231, CPT 78232: Parotid or salivary scan.

CPT 78261, CPT 78290: Gastric mucosa.

CPT 78730: Urinary bladder residual.

CPT 78740: Ureteral reflux study.

CPT 78660: Dacryocystography.

CPT 78761: Testicular imaging with vascular flow.

CPT 78291: Peritoneal-Venous Shunt Study.

CPT 78630 – CPT 78650: Cerebrospinal Fluid study.

HCPCS Code A9538

Description Of A9538: Technetium Tc-99m Pyrophosphate (PYP) (Pyrolite®) Diagnostic, per study dose, up to 25 mCi’s.

CPT Codes For A9538

CPT 78300 – CPT 78320: Bone.

CPT 78999: Amyloid imaging.

CPT 78466CPT 78469: Myocardial Infarct imaging.

HCPCS Code A9560

Description Of A9560: Technetium Tc-99m Labeled Red Blood Cell’s (RBC’s) Diagnostic, per study dose, up to 30 mCi’s, (Ultra Tag ® or cold pyrophosphate (pyp) +99m technetium).

CPT Codes For A9560

CPT 78472, CPT 78473, CPT 78494, CPT 78496: Cardiac blood pool imaging / Gated Equilibrium studies.

CPT 78278: GI bleed study.

CPT 78201, CPT 78202, CPT 78203, CPT 78204, CPT 78205, CPT 78206: Liver scan (for Hemangioma).

CPT 78445: Vascular flow study.

CPT 78457, CPT 78458: Venous thrombosis imaging.

CPT 78215, CPT 78216, CPT 78185: Spleen imaging.

HCPCS Code A9500

Description Of A9500: Technetium Tc-99m, Sestamibi, diagnostic, per study dose.

CPT Codes For A9500

CPT 78451, CPT 78452, CPT 78453, CPT 78454: Cardiac perfusion.

CPT 78070: Parathyroid study.

CPT 78605, CPT 78606, CPT 78607, CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Tumor

CPT 78800, CPT 78801: Breast tumor.

HCPCS Code A9541

Description Of A9541: Technetium Tc-99m Sulfur Colloid, Diagnostic, per study dose, up to 20 mCi’s.

CPT Codes For A9541

CPT 78201 -CPT 78216: Liver spleen scans.

CPT 78185: Spleen scan.

CPT 78278: GI bleed studies.

CPT 78102, CPT 78103, CPT 78104: Bone marrow studies.

CPT 78264, CPT 78299: Gastric emptying, gastric emptying with colonic transit studies.

CPT 78258, CPT 78262: Gastroesophageal reflux studies.

CPT 78740: Ureteral reflux study.

CPT 78730: Urinary bladder residual study.

CPT 78195: Lymphatics & Lymph glands.

CPT 78291: Peritoneal-pleural shunt studies.

HCPCS Code A9502

Description Of A9502: Technetium Tc 99m tetrofosmin, diagnostic, per study dose, (Myoview).

CPT Codes For A9502

CPT 78451, CPT 78452, CPT 78453, CPT 78454: Myocardial perfusion studies.

CPT 78070, CPT 78803: Parathyroid study.

CPT Codes For Iodine Labeled Radiopharmaceuticals

HCPCS Code A4641

Description Of A4641: Hippurate (Orthoiodohippurate) Usual Dosage 150-250 uCi

CPT Codes For A4641

CPT 78700 – CPT 78725: Renogram.

HCPCS Code A9516

Description Of A9516: Iodine I-123 Sodium iodide capsule(s), Diagnostic, per 100 Microcuries, up to 999 microcuries.

CPT Codes For A9516

CPT 78000 – CPT 78018, CPT 78020, CPT 78070: Thyroid imaging.

HCPCS Code A9509

Description Of A9509: Iodine I-123 Sodium Iodide, diagnostic, per millicurie.

CPT Codes For A9509

CPT 78000 – CPT 78018, CPT 78020, CPT 78070: Thyroid imaging.

HCPCS Code A9582

Description Of A9582: Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries (AdreView®).

CPT Codes For A9582

CPT 78075: Adrenal imaging/ Pheochromocytoma.

CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Neuroblastoma imaging.

HCPCS Code A9584

Description Of A9584: Iodine I-123 ioflupane, diagnostic, per study dose, up to 5 millicuries (DaTscan, ¢-FDA approved 01/14/2011).

CPT Code For A9582

CPT 78607: Brain Imaging, tomographic (SPECT).

HCPCS Code A9554

Description Of A9554: Iodine-125 sodium iothalamate (Glofil-125®), Diagnostic, per study dose, up to 10 microcuries.

CPT Codes For A9554

CPT 78707, CPT 78708, CPT 78709, CPT 78725: Renogram.

HCPCS Code A9532

Description Of A9532: Iodinated I-125-Serum Albumin, Diagnostic, per 5 microcuries.

CPT Codes For A9532

CPT 78110, CPT 78111, CPT 78122: Plasma Volume.

HCPCS Code A9527

Description Of A9527: Iodine- 125 Sodium Iodide solution, Therapeutic, per millicurie.

CPT Codes For A9527

CPT 79005: Hyperthyroidism or thyroid cancer.

CPT 77761: Intracavitary radiation source application, simple.

HCPCS Code A4641

Description Of A4641: Hippurate (Orthoiodohippurate), Usual Dosage 150-250 uCi

CPT Codes For A4641

CPT 78707, CPT 78708, CPT 78709, CPT 78725: Renogram.

HCPCS Code A9508

Description Of A9508: Iobenguane sulfate-Metaiodobenzyl guanidine (MIBG) per 0.5 mCi.

CPT Codes For A9508

CPT 78075: Adrenal imaging/ Pheochromocytoma.

CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Neuroblastoma imaging.

HCPCS Code A9517

Description Of A9517: Iodine I-131 Sodium Iodide capsule(s), Therapeutic, per mCi.

CPT Code For A9508

CPT 79005: Hyperthyroidism or thyroid cancer.

HCPCS Code A9530

Description Of A9530: Iodine I-131 Sodium Iodide solution, Therapeutic, per mCi.

CPT Code For A9530

CPT 79005: Hyperthyroidism or thyroid cancer.

HCPCS Code A9528

Description Of A9528: Iodine I-131 Sodium Iodide capsule(s), Diagnostic, per mCi.

CPT Codes For A9528

CPT 78000 – CPT 78020, CPT 78803: Thyroid uptake and imaging.

HCPCS Code A9529

Description Of A9529: Iodine I-131 Sodium Iodide solution, Diagnostic, per mCi.

CPT Codes For A9529

CPT 78000 – CPT 78020, CPT 78803: Thyroid uptake and imaging.

HCPCS Code A9531

Description Of A9531: Iodine I-131 Sodium Iodide, Diagnostic, per microcurie (up to 100 microcuries).

CPT Codes For A9531

CPT 78000 – CPT 78020, CPT 78803: Thyroid uptake and imaging.

HCPCS Code A9544

Description Of A9544: Iodine I-131 Tositumomab, (Bexxar®) Diagnostic, per study dose.

CPT Codes For A9544

CPT 78804: Tumor imagingIodine I-131 Tositumomab, (Bexxar®) Therapeutic, per treatment dose.

CPT 79403: Radiopharmaceutical therapy, radiolabeled monoclonal antibody by IV infusion.

HCPCS Code A9524

Description Of A9524: Iodinated I-131-Serum Albumin, diagnostic, per 5 microcuries.

CPT Codes For A9524

CPT 78110, CPT 78111, CPT 78122: Plasma Volume.

CPT 78600, CPT 78607, CPT 78610: Brain imaging.

CPT 78580, CPT 78582, CPT 78597, CPT 78598: Pulmonary perfusion imaging.

CPT 78451, CPT 78452, CPT 78453, CPT 78454: Cardiac imaging.

CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Tumor imaging.

CPT 7847, CPT 78473, CPT 78481, CPT 78482, CPT 78483: Cardiac Blood Pooling imaging.

CPT Codes For Indium Labeled Radiopharmaceuticals

HCPCS Code A9507

Description Of A9507: Indium IN 111 Capromab Pendetide (ProstaScint®) per study dose, up to 10 mci’s.

CPT Codes For A9507

CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Tumor detection.

HCPCS Code A4641

Description Of A4641: Indium -111 Diethylenetriamine Pentaacetic acid (DTPA), Usual Dosage 500 uCi.

CPT Codes For A4641

CPT 78630 – CPT 78650: Cisternography or CSF leak detection, or shunt patency evaluation.

CPT 78264: Gastric emptying.

HCPCS Code A9548

Description Of A9548: Indium IN-111 Pentetate Diagnostic, per 0.5 mCi (MPI INDIUM DTPA IN 111)

CPT Codes For A9548

CPT 78630: Cisternogram (cerebrospinal fluid flow)

CPT 78635: Cerebrospinal ventriculography.

CPT 78645: CSF Shunt evaluation.

CPT 78647: Cerebrospinal fluid scan.

CPT 78650: CSF Leakage detection and localization.

CPT 78800: Localization of tumor or distribution of radiopharmaceutical agent.

HCPCS Code A9547

Description Of A9547: Indium-IN-111 Oxyquinoline, Diagnostic, per 0.5 mCi.

CPT Codes For A9547

CPT 78805, CPT 78806, CPT 78807, CPT 78185: Leukocyte labeling.

CPT 78190, CPT 78191, CPT 78199: Platelet labeling.

HCPCS Code A9572

Description Of A9572: Indium-111 Pentetreotide (OctreoScan®), Diagnostic, per study dose, up to 6 millicuries.

CPT Codes For A9572

CPT 78075, CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804, CPT 78015-78018: Agent for localization of primary and metastatic neuroendocrine tumors bearing somatostatic receptors.

HCPCS Code A4642

Description Of A4642: Indium-111 Satumomab pendetide, diagnostic, per study dose, up to 6 mci’s (OncoScint®)

CPT Codes For A4642

CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Agent for imaging colorectal or ovarian cancers.

HCPCS Code A4641

Description Of A4641: Indium-111 Hydrochloride (HCL), Usual dosage 0.1-1.0 mCi

CPT Code For A4641

CPT 78299: Gastric emptying with colonic transit study.

HCPCS Code A9570

Description Of A9570: Indium-111 labeled autologous white blood cells, diagnostic, per study dose.

CPT Codes For A9570

CPT 78805, CPT 78806, CPT 78807, CPT 78185: Leukocyte labeling.

HCPCS Code A9571

Description Of A9571: Indium in-111 labeled autologous platelets, diagnostic, per study dose.

CPT Codes For A9571

CPT 78190, CPT78191, CPT 78199: Platelet labeling.

CPT Codes For Miscellaneous Radiopharmaceuticals

HCPCS Code A9553

Description Of A9553: Chromium CR-51 Sodium Chromate, Diagnostic, per study dose, up to 250 microcuries.

CPT Codes For A9553

CPT 78120, CPT 78121, CPT 78122: RBC Mass.

CPT 78130, CPT 78131, CPT 78132, CPT 78133, CPT 78134, CPT 78135, CPT 78140: RBC Survival.

CPT 78190, CPT 78191: Platelet Survival.

HCPCS Code A9556

Description Of A9556: Gallium Ga-67 Citrate, Diagnostic, per mCi.

CPT Codes For A9556

Used in scans searching for infections, inflammation, tumors (CPT 78800 – CPT 78807), and Sarcoidosis (CPT 78999)

HCPCS Code A9564

Description Of A9564: Chromic Phosphate P-32, suspension, Therapeutic, per mCi.

CPT Codes For A9564

CPT 79200: Therapeutic imaging agent for treatment of ovarian cancer.

HCPCS Code A9563

CPT 79300, CPT 79445: Interstitial radioactive colloid therapy.

Description Of A9563: Sodium Phosphate P-32, Therapeutic, per mCi.

CPT Code For A9563

CPT 79101: Therapeutic imaging agent for treatment of polycythemia vera or thrombocythemia.

HCPCS Code A9600

Description Of A9600: Strontium SR-89 Chloride (Metastron®), Therapeutic, per mCi.

CPT Code For A9600

CPT 79101: Therapeutic for treatment of bone pain due to skeletal metastases.

HCPCS Code A9604

Description Of A9604: Samarium SM-153 Lexidronam (Quadramet®) Therapeutic, per treatment dose up to 150 millicuries.

CPT Code For A9604

CPT 79101: Therapeutic for the treatment of pain in patients with confirmed osteoblastic metastatic bone lesions that enhance on radionuclide bone scan.

HCPCS Code A9505

Description Of A9505: Thallous Chloride TL-201, diagnostic, per mCi.

CPT Codes For A9505

CPT 78451, CPT 78452, CPT 78453, CPT 78454: Cardiac imaging.

CPT 78070: Parathyroid imaging.

CPT 78800, CPT 78801, CPT 78802, CPT 78803, CPT 78804: Tumor imaging.

CPT 78607: Brain imaging.

HCPCS Code A9558

Description Of A9558: Xenon Xe-133 Gas, Diagnostic, per 10 mCi’s.

CPT Codes For A9558

CPT 78579, CPT 78580, CPT 78582, CPT 78597, CPT 78598: Lung study.

Pet Scan Radiopharmaceuticals

The payment for the radio-tracer or radiopharmaceuticals will be reimbursed for pet scans.

  1. A9555: Rubidium RB-82.
  2. A9552: Fluorodeoxyglucose (F-18 FDG).
  3. A9526: Ammonia N-13.

The following agents are no longer marketed in the United States and will be denied. Coverage will be added if the agent(s) become available in the future.

  1. A9501: Technetium Tc-99m Teboroxime (Cardiotec®).
  2. A9504: Technetium Tc 99m Apcitide (Acu Tect®).
  3. A9536: Technetium Tc-99M Depreotide, (Neotect®).
  4. A9550: Technetium Tc-99m Sodium Gluceptate (Glucoheptonate®).
  5. A9566: Technetium Tc-99m Fanolesomab, (NeutroSpec®).
  6. A9546: Cobalt CO-57-/58 Cyanocobalamin.
  7. A9559: Cobalt CO-57 Cyanocobalamin, oral.

Use of radiopharmaceuticals is regulated by the Nuclear Regulatory Commission (NRC) under strict procedures and guidelines. Persons administering radiopharmaceuticals should have either a license from the NRC or be credentialed by an institution having a broad license from the NRC.

Similar Posts

2 Comments

  1. Kay Larsen says:

    This article is a great resource! Are there any updates for 2021?

    1. Hi Kay, thanks. We didn’t look into changes for 2021 yet. Keep an eye on our website. We’ll look into it soon!

Leave a Reply

Your email address will not be published.