Code |
Description |
Effective "from" date of service |
Effective "through" date of service |
---|---|---|---|
A4642 |
Indium In-111 satumomab pendetide, diagnostic, per study dose up to 6 millicuries |
1/1/2024 |
Present |
A9501 |
Technetium Tc-99m teboroxime, diagnostic, per study dose |
1/1/2024 |
Present |
A9503 |
Technetium Tc-99m medronate, diagnostic, per study dose, up to 30 mCi |
1/1/2024 |
Present |
A9504 |
Technetium Tc-99m apcitide, diagnostic, per study dose, up to 20 mCi |
1/1/2024 |
Present |
A9507 |
Indium In-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries |
1/1/2024 |
Present |
A9508 |
Iodine I-131 iobenguane sulfate, diagnostic, per 0.5 mCi |
1/1/2024 |
Present |
A9509 |
Iodine I-123 sodium iodide, diagnostic, per mCi |
1/1/2024 |
Present |
A9510 |
Technetium Tc-99m disofenin, diagnostic, per study dose, up to 15 mCi |
1/1/2024 |
Present |
A9512 |
Technetium Tc-99m pertechnetate, diagnostic, per mCi |
1/1/2024 |
Present |
A9516 |
Iodine I-123 sodium iodide, diagnostic, per 100 mcCi, up to 999 mcCi |
1/1/2024 |
Present |
A9517 |
Iodine I-131 sodium iodide capsule(s), therapeutic, per mCi |
1/1/2024 |
Present |
A9526 |
Nitrogen N-13 ammonia, diagnostic, per study dose, up to 40 mCi |
1/1/2024 |
Present |
A9527 |
Iodine I-125, sodium iodide solution, therapeutic, per mCi |
1/1/2024 |
Present |
A9528 |
Iodine I-131 sodium iodide capsule(s), diagnostic, per mCi |
1/1/2024 |
Present |
A9529 |
Iodine I-131 sodium iodide solution, diagnostic, per mCi |
1/1/2024 |
Present |
A9530 |
Iodine I-131 sodium iodide solution, therapeutic, per mCi |
1/1/2024 |
Present |
A9531 |
Iodine I-131 sodium iodide, diagnostic, per mcCi (up to 100 mcCi) |
1/1/2024 |
Present |
A9532 |
Iodine I-125 serum albumin, diagnostic, per 5 mcCi |
1/1/2024 |
Present |
A9536 |
Technetium Tc-99m depreotide, diagnostic, per study dose, up to 35 mCi |
1/1/2024 |
Present |
A9538 |
Technetium Tc-99m pyrophosphate, diagnostic, per study dose, up to 25 mCi |
1/1/2024 |
Present |
A9539 |
Technetium Tc-99m pentetate, diagnostic, per study dose, up to 25 mCi |
1/1/2024 |
Present |
A9540 |
Technetium Tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 mCi |
1/1/2024 |
Present |
A9541 |
Technetium Tc-99m sulfur colloid, diagnostic, per study dose, up to 20 mCi |
1/1/2024 |
Present |
A9542 |
Indium In-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 mCi |
1/1/2024 |
Present |
A9546 |
Cobalt Co-57/58, cyanocobalamin, diagnostic, per study dose, up to 1 mcCi |
1/1/2024 |
Present |
A9550 |
Technetium Tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 mCi |
1/1/2024 |
Present |
A9553 |
Chromium Cr-51 sodium chromate, diagnostic, per study dose, up to 250 mcCi |
1/1/2024 |
Present |
A9557 |
Technetium Tc-99m bicisate, diagnostic, per study dose, up to 25 mCi |
1/1/2024 |
Present |
A9559 |
Cobalt Co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1 mcCi |
1/1/2024 |
Present |
A9560 |
Technetium Tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 mCi |
1/1/2024 |
Present |
A9561 |
Technetium Tc-99m oxidronate, diagnostic, per study dose, up to 30 mCi |
1/1/2024 |
Present |
A9562 |
Technetium Tc-99m mertiatide, diagnostic, per study dose, up to 15 mCi |
1/1/2024 |
Present |
A9563 |
Sodium phosphate P-32, therapeutic, per mCi |
1/1/2024 |
Present |
A9564 |
Chromic phosphate P-32 suspension, therapeutic, per mCi |
1/1/2024 |
Present |
A9566 |
Technetium Tc-99m fanolesomab, diagnostic, per study dose, up to 25 mCi |
1/1/2024 |
Present |
A9567 |
Technetium Tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 mCi |
1/1/2024 |
Present |
A9569 |
Technetium Tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose |
1/1/2024 |
Present |
A9570 |
Indium In-111 labeled autologous white blood cells, diagnostic, per study dose |
1/1/2024 |
Present |
A9571 |
Indium In-111 labeled autologous platelets, diagnostic, per study dose |
1/1/2024 |
Present |
A9572 |
Indium In-111 pentetreotide, diagnostic, per study dose, up to 6 mCi |
1/1/2024 |
Present |
A9580 |
Sodium fluoride F-18, diagnostic, per study dose, up to 30 mCi |
1/1/2024 |
Present |
A9583 |
Injection, gadofosveset trisodium, 1 ml |
1/1/2024 |
Present |
A9586 |
Florbetapir F18, diagnostic, per study dose, up to 10 mCi |
1/1/2024 |
Present |
A9590 |
Iodine I-131, iobenguane, 1 mCi |
1/1/2024 |
Present |
A9597 |
Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified |
1/1/2024 |
Present |
A9598 |
Positron emission tomography radiopharmaceutical, diagnostic, for nontumor identification, not otherwise classified |
1/1/2024 |
Present |
A9601 |
Flortaucipir F 18 injection, diagnostic, 1 mCi |
1/1/2024 |
Present |
A9602 |
Fluorodopa f-18, diagnostic, per mCi |
1/1/2024 |
Present |
A9603 |
Injection, pafolacianine, 0.1 mg |
1/1/2024 |
Present |
A9609 |
Fludeoxyglucose f18 up to 15 millicuries |
1/1/2024 |
Present |
A9610 |
Xenon xe-129 hyperpolarized gas, diagnostic, per study dose |
10/1/2024 |
Present |
A9697 |
Injection, carboxydextran-coated superparamagnetic iron oxide, per study dose |
1/1/2024 |
Present |
A9698 |
Nonradioactive contrast imaging material, not otherwise classified, per study |
1/1/2024 |
Present |
A9700 |
Supply of injectable contrast material for use in echocardiography, per study |
1/1/2024 |
Present |