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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.
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
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
A9698 Non-radioactive contrast imaging material, noc, per study
A9700 Supply of injectable contrast material for use in echocardiography, per study
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

Procedure codes A9592, A9593, A9594, A9595 and C9067 have been added to this program effective January 1, 2022.