Codes Considered Inclusive to an Imaging Service
Reimbursement for the services represented by the HCPCS codes below is considered included in the reimbursement for the radiology/cardiology imaging service performed.
- Contrast agents billed in conjunction with an MRI.
- Radiopharmaceuticals billed in conjunction with a PET scan.
- Materials billed with a CT or other radiographic study not mentioned above.
- Non-Ionic Contrasts or low osmolar contrast material.
- Isotopes for therapeutic purposes are not covered under these payment rules.
This information was last revised on January 23, 2023 and may be subject to change.
Recent Changes
- Procedure codes A9596, A9601, A9602 and A9800 have been added to this program effective January 1, 2023.
- Procedure codes A9592, A9593, A9594, A9595 and C9067 have been added to this program effective January 1, 2022.
| Code | Code Description
|
| A9515 | Choline c-11, diagnostic, per study dose up to 20 millicuries |
| A9526 | Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries |
| A9552 | Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
| A9555 | Rubidium Rb-82, diagnostic, per study dose, up to 60 millicuries |
| A9575 | Injection, gadoterate meglumine, 0.1 ml |
| A9576 | Injection, gadoteridol, (prohance multipack), per ml |
| A9577 | Injection, gadobenate dimeglumine (multihance), per ml |
| A9578 | Injection, gadobenate dimeglumine (multihance multipack), per ml |
| A9579 | Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (NOS) |
| A9580 | Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries |
| A9581 | Injection, gadoxetate disodium, 1 ml |
| A9585 | Injection, gadobutrol, 0.1 ml |
| A9586 | Florbetapir f18, diagnostic, per study dose, up to 10 millicuries |
| A9587 | Gallium ga-68, dotatate, diagnostic, 0.1 millicurie |
| A9588 | Fluciclovine f-18, diagnostic, 1 millicurie |
| A9592 | Copper Cu-64, dotatate, diagnostic, 1 millicurie |
| A9593 | Gallium ga-68 psma-11, diagnostic, (ucsf), 1 millicurie |
| A9594 | Gallium ga-68 psma-11, diagnostic, (ucla), 1 millicurie |
| A9595 | Piflufolastat f-18, diagnostic, 1 millicurie |
| A9596 | Gallium Ga-68 gozetotide, diagnostic, (Illuccix), 1 mCi |
| A9597 | Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified |
| A9598 | Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified |
| A9601 | Flortaucipir F 18 injection, diagnostic, 1 mCi |
| A9602 | Fluorodopa f-18, diagnostic, per mCi |
| A9698 | Non-radioactive contrast imaging material, noc, per study |
| A9700 | Supply of injectable contrast material for use in echocardiography, per study |
| A9800 | Gallium Ga-68 gozetotide, diagnostic, (Locametz), 1 mCi |
| C9067 | Gallium ga-68, dotatoc, diagnostic, 0.01 mci |
| Q9951 | Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml |
| Q9953 | Injection, iron-based magnetic resonance contrast agent |
| Q9954 | Oral magnetic resonance contrast agent, per ml |
| Q9957 | Injection, perflutren lipid microspheres, per ml |
| Q9958 | High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml |
| Q9959 | High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml |
| Q9960 | High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml |
| Q9961 | High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml |
| Q9963 | High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml |
| Q9965 | Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml |
| Q9966 | Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
| Q9967 | Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
| Q9968 | Methylene blue, isosulfan blue), 1 mg |
| Q9982 | Flutemetamol F18, diagnostic, per study dose, up to 5 millicuries |
| Q9983 | Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries |