Radiopharmaceuticals HCPCS 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 HCPCS 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.
HCPCS 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.
HCPCS Code A9551
Description Of A9551: Technetium Tc-99m Succimer (DMSA), Diagnostic, per study dose, up to 10 mCi’s.
HCPCS Code A9539
Description Of A9539: Technetium Tc-99m Pentetate, Diagnostic, per study dose, up to 25 mCi’s.
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.
HCPCS Code A9521
Description Of A9521: Technetium Tc-99m Exametazine (Ceretec®), Diagnostic, per study dose, up to 25 mCi’s.
HCPCS Code A9569
Description Of A9569: Technetium TC-99m Exametazime labeled autologous white blood cells, Diagnostic, per study dose.
HCPCS Code A4641
Description Of A4641: TechnetiumTc-99m Human Serum Albumin Usual Dosage 2-20 mCi.
HCPCS Code A9540
Description Of A9540: Technetium Tc-99m Macroaggregated Albumin (MAA), Diagnostic, per study dose, up to 10 mCi’s.
HCPCS Code A9537
Description Of A9537: Technetium Tc-99m Mebrofenin (Choletec) Diagnostic, per study dose, up to 15 mCi’s.
HCPCS Code A9562
Description Of A9562: Technetium Tc-99m Mertiatide (MAG-3), diagnostic, per study dose, up to 15 mCi’s.
HCPCS Code A9503
Description Of A9503: Technetium Tc 99m, Medronate, (MDP), diagnostic, per study dose, up to 30 mCi’s.
HCPCS Code A9561
Description Of A9561: Technetium Tc-99m Oxidronate, Diagnostic, per study dose, up to 30 mCi’s.
HCPCS Code A9512
Description Of A9512: Technetium Tc-99m-Pertechnetate, Diagnostic, per mCi.
HCPCS Code A9538
Description Of A9538: Technetium Tc-99m Pyrophosphate (PYP) (Pyrolite®) Diagnostic, per study dose, up to 25 mCi’s.
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).
HCPCS Code A9500
Description Of A9500: Technetium Tc-99m, Sestamibi, diagnostic, per study dose.
HCPCS Code A9541
Description Of A9541: Technetium Tc-99m Sulfur Colloid, Diagnostic, per study dose, up to 20 mCi’s.
HCPCS Code A9502
Description Of A9502: Technetium Tc 99m tetrofosmin, diagnostic, per study dose, (Myoview).
HCPCS Codes For Iodine Labeled Radiopharmaceuticals
HCPCS Code A4641
Description Of A4641: Hippurate (Orthoiodohippurate) Usual Dosage 150-250 uCi
HCPCS Code A9516
Description Of A9516: Iodine I-123 Sodium iodide capsule(s), Diagnostic, per 100 Microcuries, up to 999 microcuries.
HCPCS Code A9509
Description Of A9509: Iodine I-123 Sodium Iodide, diagnostic, per millicurie.
HCPCS Code A9582
Description Of A9582: Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries (AdreView®).
HCPCS Code A9584
Description Of A9584: Iodine I-123 ioflupane, diagnostic, per study dose, up to 5 millicuries (DaTscan, ¢-FDA approved 01/14/2011).
HCPCS Code A9554
Description Of A9554: Iodine-125 sodium iothalamate (Glofil-125®), Diagnostic, per study dose, up to 10 microcuries.
HCPCS Code A9532
Description Of A9532: Iodinated I-125-Serum Albumin, Diagnostic, per 5 microcuries.
HCPCS Code A9527
Description Of A9527: Iodine- 125 Sodium Iodide solution, Therapeutic, per millicurie.
HCPCS Code A4641
Description Of A4641: Hippurate (Orthoiodohippurate), Usual Dosage 150-250 uCi
HCPCS Code A9508
Description Of A9508: Iobenguane sulfate-Metaiodobenzyl guanidine (MIBG) per 0.5 mCi.
HCPCS Code A9517
Description Of A9517: Iodine I-131 Sodium Iodide capsule(s), Therapeutic, per mCi.
HCPCS Code A9530
Description Of A9530: Iodine I-131 Sodium Iodide solution, Therapeutic, per mCi.
HCPCS Code A9528
Description Of A9528: Iodine I-131 Sodium Iodide capsule(s), Diagnostic, per mCi.
HCPCS Code A9529
Description Of A9529: Iodine I-131 Sodium Iodide solution, Diagnostic, per mCi.
HCPCS Code A9531
Description Of A9531: Iodine I-131 Sodium Iodide, Diagnostic, per microcurie (up to 100 microcuries).
HCPCS Code A9544
Description Of A9544: Iodine I-131 Tositumomab, (Bexxar®) Diagnostic, per study dose.
HCPCS Code A9524
Description Of A9524: Iodinated I-131-Serum Albumin, diagnostic, per 5 microcuries.
HCPCS 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.
HCPCS Code A4641
Description Of A4641: Indium -111 Diethylenetriamine Pentaacetic acid (DTPA), Usual Dosage 500 uCi.
HCPCS Code A9548
Description Of A9548: Indium IN-111 Pentetate Diagnostic, per 0.5 mCi (MPI INDIUM DTPA IN 111)
HCPCS Code A9547
Description Of A9547: Indium-IN-111 Oxyquinoline, Diagnostic, per 0.5 mCi.
HCPCS Code A9572
Description Of A9572: Indium-111 Pentetreotide (OctreoScan®), Diagnostic, per study dose, up to 6 millicuries.
HCPCS Code A4642
Description Of A4642: Indium-111 Satumomab pendetide, diagnostic, per study dose, up to 6 mci’s (OncoScint®)
HCPCS Code A4641
Description Of A4641: Indium-111 Hydrochloride (HCL), Usual dosage 0.1-1.0 mCi
HCPCS Code A9570
Description Of A9570: Indium-111 labeled autologous white blood cells, diagnostic, per study dose.
HCPCS Code A9571
Description Of A9571: Indium in-111 labeled autologous platelets, diagnostic, per study dose.
HCPCS Codes For Miscellaneous Radiopharmaceuticals
HCPCS Code A9553
Description Of A9553: Chromium CR-51 Sodium Chromate, Diagnostic, per study dose, up to 250 microcuries.
HCPCS Code A9556
Description Of A9556: Gallium Ga-67 Citrate, Diagnostic, per mCi.
HCPCS Code A9564
Description Of A9564: Chromic Phosphate P-32, suspension, Therapeutic, per mCi.
HCPCS Code A9563
Description Of A9563: Sodium Phosphate P-32, Therapeutic, per mCi.
HCPCS Code A9600
Description Of A9600: Strontium SR-89 Chloride (Metastron®), Therapeutic, per mCi.
HCPCS Code A9604
Description Of A9604: Samarium SM-153 Lexidronam (Quadramet®) Therapeutic, per treatment dose up to 150 millicuries.
HCPCS Code A9505
Description Of A9505: Thallous Chloride TL-201, diagnostic, per mCi.
HCPCS Code A9558
Description Of A9558: Xenon Xe-133 Gas, Diagnostic, per 10 mCi’s.
Pet Scan Radiopharmaceuticals
The payment for the radio-tracer or radiopharmaceuticals will be reimbursed for pet scans.
- A9555: Rubidium RB-82.
- A9552: Fluorodeoxyglucose (F-18 FDG).
- 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.
- A9501: Technetium Tc-99m Teboroxime (Cardiotec®).
- A9504: Technetium Tc 99m Apcitide (Acu Tect®).
- A9536: Technetium Tc-99M Depreotide, (Neotect®).
- A9550: Technetium Tc-99m Sodium Gluceptate (Glucoheptonate®).
- A9566: Technetium Tc-99m Fanolesomab, (NeutroSpec®).
- A9546: Cobalt CO-57-/58 Cyanocobalamin.
- 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.
This article is a great resource! Are there any updates for 2021?
Hi Kay, thanks. We didn’t look into changes for 2021 yet. Keep an eye on our website. We’ll look into it soon!