A95 — HCPCS Level II Codes

• A9500 Technetium tc-99m sestamibi, diagnostic, per study dose billable
• A9501 Technetium tc-99m teboroxime, diagnostic, per study dose billable
• A9502 Technetium tc-99m tetrofosmin, diagnostic, per study dose billable
• A9503 Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries billable
• A9504 Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries billable
• A9505 Thallium tl-201 thallous chloride, diagnostic, per millicurie billable
• A9506 Graphite crucible for preparation of technetium tc 99m-labeled carbon aerosol, one crucible billable
• A9507 Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries billable
• A9508 Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie billable
• A9509 Iodine i-123 sodium iodide, diagnostic, per millicurie billable
• A9510 Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries billable
• A9512 Technetium tc-99m pertechnetate, diagnostic, per millicurie billable
• A9513 Lutetium lu 177, dotatate, therapeutic, 1 millicurie billable
• A9515 Choline c-11, diagnostic, per study dose up to 20 millicuries billable
• A9516 Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries billable
• A9517 Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie billable
• A9520 Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries billable
• A9521 Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries billable
• A9524 Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries billable
• A9526 Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries billable
• A9527 Iodine i-125, sodium iodide solution, therapeutic, per millicurie billable
• A9528 Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie billable
• A9529 Iodine i-131 sodium iodide solution, diagnostic, per millicurie billable
• A9530 Iodine i-131 sodium iodide solution, therapeutic, per millicurie billable
• A9531 Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries) billable
• A9532 Iodine i-125 serum albumin, diagnostic, per 5 microcuries billable
• A9536 Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries billable
• A9537 Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries billable
• A9538 Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries billable
• A9539 Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries billable
• A9540 Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries billable
• A9541 Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries billable
• A9542 Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries billable
• A9543 Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries billable
• A9546 Cobalt co-57/58, cyanocobalamin, diagnostic, per study dose, up to 1 microcurie billable
• A9547 Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie billable
• A9548 Indium in-111 pentetate, diagnostic, per 0.5 millicurie billable
• A9550 Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 millicurie billable
• A9551 Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries billable
• A9552 Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries billable
• A9553 Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries billable
• A9554 Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries billable
• A9555 Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries billable
• A9556 Gallium ga-67 citrate, diagnostic, per millicurie billable
• A9557 Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries billable
• A9558 Xenon xe-133 gas, diagnostic, per 10 millicuries billable
• A9559 Cobalt co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1 microcurie billable
• A9560 Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries billable
• A9561 Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries billable
• A9562 Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries billable
• A9563 Sodium phosphate p-32, therapeutic, per millicurie billable
• A9564 Chromic phosphate p-32 suspension, therapeutic, per millicurie billable
• A9566 Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries billable
• A9567 Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries billable
• A9568 Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries billable
• A9569 Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose billable
• A9570 Indium in-111 labeled autologous white blood cells, diagnostic, per study dose billable
• A9571 Indium in-111 labeled autologous platelets, diagnostic, per study dose billable
• A9572 Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries billable
• A9573 Injection, gadopiclenol, 1 ml billable
• A9574 Injection, ferumoxytol, 1 mg billable
• A9575 Injection, gadoterate meglumine, 0.1 ml billable
• A9576 Injection, gadoteridol, (prohance multipack), per ml billable
• A9577 Injection, gadobenate dimeglumine (multihance), per ml billable
• A9578 Injection, gadobenate dimeglumine (multihance multipack), per ml billable
• A9579 Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml billable
• A9580 Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries billable
• A9581 Injection, gadoxetate disodium, 1 ml billable
• A9582 Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries billable
• A9583 Injection, gadofosveset trisodium, 1 ml billable
• A9584 Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries billable
• A9585 Injection, gadobutrol, 0.1 ml billable
• A9586 Florbetapir f18, diagnostic, per study dose, up to 10 millicuries billable
• A9587 Gallium ga-68, dotatate, diagnostic, 0.1 millicurie billable
• A9588 Fluciclovine f-18, diagnostic, 1 millicurie billable
• A9589 Instillation, hexaminolevulinate hydrochloride, 100 mg billable
• A9590 Iodine i-131, iobenguane, 1 millicurie billable
• A9591 Fluoroestradiol f 18, diagnostic, 1 millicurie billable
• A9592 Copper cu-64, dotatate, diagnostic, 1 millicurie billable
• A9593 Gallium ga-68 psma-11, diagnostic, (ucsf), 1 millicurie billable
• A9594 Gallium ga-68 psma-11, diagnostic, (ucla), 1 millicurie billable
• A9595 Piflufolastat f-18, diagnostic, 1 millicurie billable
• A9596 Gallium ga-68 gozetotide, diagnostic, (illuccix), 1 millicurie billable
• A9597 Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified billable
• A9598 Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified billable