HMSA allows radiopharmaceutical agents when used in combination with an appropriate nuclear medicine procedure. When billing radiopharmaceutical agent codes, the appropriate nuclear medicine procedure code must also be billed.
Effective 1/1/19, Max allowable billed units for radiopharmaceutical agents will follow Medicare’s Medically Unlikely Edits (MUEs) Units of Service (UOS) and will be reviewed quarterly as they are subject to change.
Radiopharmaceutical Codes for Billing HMSA
Diagnostic agents
| Code | Agent/Description | Max Allowable Billed Units |
|---|---|---|
| A4642 | INDIUM IN-111 SATUMOMAB PENDETIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 6 MILLICURIES | 1 |
| A9500 | TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE | 3 |
| A9501 | TECHNETIUM TC-99M TEBOROXIME, DIAGNOSTIC, PER STUDY DOSE | 1 |
| A9502 | TECHNETIUM TC-99M TETROFOSMIN, DIAGNOSTIC, PER STUDY DOSE | 3 |
| A9503 | TECHNETIUM TC-99M MEDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES | 1 |
| A9504 | TECHNETIUM TC-99M APCITIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURIES | 1 |
| A9505 | THALLIUM TL-201 THALLOUS CHLORIDE, DIAGNOSTIC, PER MILLICURIE | 4 |
| A9507 | INDIUM IN-111 CAPROMAB PENDETIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES | 1 |
| A9508 | IODINE I-131 IOBENGUANE SULFATE, DIAGNOSTIC, PER 0.5 MILLICURIE | 2 |
| A9509 | IODINE I-123 SODIUM IODIDE, DIAGNOSTIC, PER MILLICURIE | 5 |
| A9510 | TECHNETIUM TC-99M DISOFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES | 1 |
| A9512 | TECHNETIUM TC-99M PERTECHNETATE, DIAGNOSTIC, PER | 30 |
| A9515 | CHOLINE C-11, DIAGNOSTIC, PER STUDY DOSE UP TO 20 MILLICURIES | 1 |
| A9516 | IODINE I-123 SODIUM IODIDE, DIAGNOSTIC, PER 100 MICROCURIES, UP TO 999 MICROCURIES | 4 |
| A9520 | TECHNETIUM TC-99M TILMANOCEPT, DIAGNOSTIC, UP TO 0.5 MILLICURIES | 1 |
| A9521 | TECHNETIUM TC-99M EXAMETAZIME, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES | 2 |
| A9524 | IODINE I-131 IODINATED SERUM ALBUMIN, DIAGNOSTIC, PER 5 MICROCURIES | 10 |
| A9526 | NITROGEN N-13 AMMONIA, DIAGNOSTIC, PER STUDY DOSE, UP TO 40 MILLICURIES | 2 |
| A9528 | IODINE I-131 SODIUM IODIDE CAPSULE(S), DIAGNOSTIC, PER MILLICURIE | 10 |
| A9529 | IODINE I-131 SODIUM IODIDE SOLUTION, DIAGNOSTIC, PER MILLICURIE | 10 |
| A9531 | IODINE I-131 SODIUM IODIDE, DIAGNOSTIC, PER MICROCURIE (UP TO 100 MICROCURIES) | 100 |
| A9532 | IODINE I-125 SERUM ALBUMIN, DIAGNOSTIC, PER 5 MICROCURIES | 10 |
| A9536 | TECHNETIUM TC-99M DEPREOTIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 35 MILLICURIES | 1 |
| A9537 | TECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES | 1 |
| A9538 | TECHNETIUM TC-99M PYROPHOSPHATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES | 1 |
| A9539 | TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES | 2 |
| A9540 | TECHNETIUM TC-99M MACROAGGREGATED ALBUMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES | 2 |
| A9541 | TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURIES | 1 |
| A9542 | INDIUM IN-111 IBRITUMOMAB TIUXETAN, DIAGNOSTIC, PER STUDY DOSE, UP TO 5 MILLICURIES | 1 |
| A9546 | COBALT CO-57/58, CYANOCOBALAMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 1 MICROCURIE | 1 |
| A9547 | INDIUM IN-111 OXYQUINOLINE, DIAGNOSTIC, PER 0.5 MILLICURIE | 2 |
| A9548 | INDIUM IN-111 PENTETATE, DIAGNOSTIC, PER 0.5 MILLICURIE | 2 |
| A9550 | TECHNETIUM TC-99M SODIUM GLUCEPTATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIE | 1 |
| A9551 | TECHNETIUM TC-99M SUCCIMER, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES | 1 |
| A9552 | FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES | 1 |
| A9553 | CHROMIUM CR-51 SODIUM CHROMATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 250 MICROCURIES | 1 |
| A9554 | IODINE I-125 SODIUM IOTHALAMATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MICROCURIES | 1 |
| A9555 | RUBIDIUM RB-82, DIAGNOSTIC, PER STUDY DOSE, UP TO 60 MILLICURIES | 2 |
| A9556 | TECHNETIUM TC-99M FANOLESOMAB, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES | 10 |
| A9557 | TECHNETIUM TC-99M BICISATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES | 2 |
| A9558 | XENON XE-133 GAS, DIAGNOSTIC, PER 10 MILLICURIES | 7 |
| A9559 | COBALT CO-57 CYANOCOBALAMIN, ORAL, DIAGNOSTIC, PER STUDY DOSE, UP TO 1 MICROCURIE | 1 |
| A9560 | TECHNETIUM TC-99M LABELED RED BLOOD CELLS, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES | 2 |
| A9561 | TECHNETIUM TC-99M OXIDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES | 1 |
| A9562 | TECHNETIUM TC-99M MERTIATIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES | 2 |
| A9566 | TECHNETIUM TC-99M FANOLESOMAB, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES | 1 |
| A9567 | TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, AEROSOL, PER STUDY DOSE, UP TO 75 MILLICURIES | 2 |
| A9569 | TECHNETIUM TC-99M EXAMETAZIME LABELED AUTOLOGOUS WHITE BLOOD CELLS, DIAGNOSTIC, PER STUDY DOSE | 1 |
| A9570 | INDIUM IN-111 LABELED AUTOLOGOUS WHITE BLOOD CELLS, DIAGNOSTIC, PER STUDY DOSE | 1 |
| A9571 | INDIUM IN-111 LABELED AUTOLOGOUS PLATELETS, DIAGNOSTIC, PER STUDY DOSE | 1 |
| A9572 | INDIUM IN-111 PENTETREOTIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 6 MILLICURIES | 1 |
| A9575 | INJECTION, GADOTERATE MEGLUMINE, 0.1 ML | 300 |
| A9576 | INJECTION, GADOTERIDOL, (PROHANCE MULTIPACK), PER ML | 40 |
| A9577 | INJECTION, GADOBENATE DIMEGLUMINE (MULTIHANCE), PER ML | 50 |
| A9578 | INJECTION, GADOBENATE DIMEGLUMINE (MULTIHANCE MULTIPACK), PER ML | 50 |
| A9579 | INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, NOT OTHERWISE SPECIFIED (NOS), PER ML | 100 |
| A9580 | SODIUM FLUORIDE F-18, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES | 1 |
| A9581 | INJECTION, GADOXETATE DISODIUM, 1 ML | 20 |
| A9582 | IODINE I-123 IOBENGUANE, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES | 1 |
| A9583 | INJECTION, GADOFOSVESET TRISODIUM, 1 ML | 18 |
| A9584 | IODINE 1-123 IOFLUPANE, DIAGNOSTIC, PER STUDY DOSE, UP TO 5 MILLICURIES | 1 |
| A9585 | INJECTION, GADOBUTROL, 0.1 ML | 300 |
| A9586 | FLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES | 1 |
| A9587 | GALLIUM GA-68, DOTATATE, DIAGNOSTIC, 0.1 MILLICURIE | 54 |
| A9588 | FLUCICLOVINE F-18, DIAGNOSTIC, 1 MILLICURIE | 10 |
| A9599 | RADIOPHARMACEUTICAL, DIAGNOSTIC, FOR BETA-AMYLOID POSITRON EMISSION TOMOGRAPHY (PET) IMAGING, PER STUDY DOSE, NOT OTHERWISE SPECIFIED | 1 |
| A9698 | NON-RADIOACTIVE CONTRAST IMAGING MATERIAL, NOT OTHERWISE CLASSIFIED, PER STUDY | 2 |
- Please be sure to use the most up-to-date industry-standard procedure, revenue, and diagnosis codes form the current CPT®, HCPCS Level II, and ICD-10-CM manuals, as recommended by the American Medical Association (AMA), the Centers for Medicare & Medicaid Services (CMS), and the American Hospital Association.
- Codes may not be all inclusive as the AMA and CMS code updates may occur more frequently.
- Presence/absence of code does not guarantee payment. Payment, medical and benefit policies apply.
Therapeutic agents
| Code | Agent/Description | Max Allowable Billed Units |
|---|---|---|
| A9517 | IODINE I-131 SODIUM IODIDE CAPSULE(S), THERAPEUTIC, PER MILLICURIE | 200 |
| A9527 | IODINE I-125, SODIUM IODIDE SOLUTION, THERAPEUTIC, PER MILLICURIE | 195 |
| A9530 | IODINE I-131 SODIUM IODIDE SOLUTION, THERAPEUTIC, PER MILLICURIE | 200 |
| A9543 | YTTRIUM Y-90 IBRITUMOMAB TIUXETAN, THERAPEUTIC, PER TREATMENT DOSE, UP TO 40 MILLICURIES | 1 |
| A9563 | SODIUM PHOSPHATE P-32, THERAPEUTIC, PER MILLICURIE | 10 |
| A9564 | CHROMIC PHOSPHATE P-32 SUSPENSION, THERAPEUTIC, PER MILLICURIE | 20 |
| A9600 | STRONTIUM SR-89 CHLORIDE, THERAPEUTIC, PER MILLICURIE | 7 |
| A9604 | SAMARIUM SM-153 LEXIDRONAM, THERAPEUTIC, PER TREATMENT DOSE, UP TO 150 MILLICURIES | 1 |
| A9606 | RADIUM RA-223 DICHLORIDE, THERAPEUTIC, PER MICROCURIE | 224 |
Radiopharmaceutical Agents with no MUE value
| Code | Agent/Description | Max Allowable Billed Units |
|---|---|---|
| A4641 | RADIOPHARMACEUTICAL, DIAGNOSTIC, NOT OTHERWISE CLASSIFIED | 0 |
| A9568 | TECHNETIUM TC-99M ARCITUMOMAB, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES | 0 |
| A9597 | POSITRON EMISSION TOMOGRAPHY RADIOPHARMACEUTICAL, DIAGNOSTIC, FOR TUMOR IDENTIFICATION, NOT OTHERWISE CLASSIFIED | 0 |
| A9598 | POSITRON EMISSION TOMOGRAPHY RADIOPHARMACEUTICAL, DIAGNOSTIC, FOR NON-TUMOR IDENTIFICATION, NOT OTHERWISE CLASSIFIED | 0 |
| A9699 | RADIOPHARMACEUTICAL, THERAPEUTIC, NOT OTHERWISE CLASSIFIED | 0 |
Unlisted Radiopharmaceutical Agent Codes
If there is no standard code that describes the radiopharmaceutical agent, the use of an unlisted radiopharmaceutical agent code, such as A4641, A9579, A9598, A9599, A9698, or A9699, is acceptable. When billing any of the unlisted radiopharmaceutical agent codes, be sure to include the name of the agent, the NDC number, and the dosage administered.
Claims Filing Tip
Accurately coding the number of units used for these codes is essential to ensure accurate claims payment.
Medicare’s MUE link:
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |