Summary & Overview
HCPCS A4642: Indium In-111 satumomab pendetide diagnostic imaging, per dose
HCPCS Level II code A4642 denotes a diagnostic radiopharmaceutical, Indium In-111 satumomab pendetide, billed per study dose up to 6 millicuries. This code is used when the agent is administered for nuclear medicine imaging to localize tumor-associated antigens and guide diagnostic evaluation. Nationally, radiopharmaceutical billing codes like A4642 matter because they affect coverage determinations, imaging utilization, and reimbursement workflows for hospitals, outpatient imaging centers, and specialty nuclear medicine providers.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the agent, typical sites of service where it is administered, and the payer landscape considered. The publication summarizes billing considerations and common modifier usage patterns, presents benchmarking concepts for reimbursement and utilization, and outlines policy and documentation factors that commonly influence coverage decisions. Data not available in the input is explicitly noted where applicable in detailed sections.
Billing Code Overview
HCPCS Level II code A4642 represents Indium In-111 satumomab pendetide diagnostic imaging provided per study dose, up to 6 millicuries. This code describes a radiopharmaceutical agent used for diagnostic nuclear medicine imaging studies.
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Service type: Diagnostic radiopharmaceutical administration for nuclear medicine imaging
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Typical site of service: Hospital outpatient nuclear medicine departments, ambulatory imaging centers, and specialized nuclear medicine clinics
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a known or suspected epithelial carcinoma (for example, colorectal or ovarian cancer) being evaluated for tumor localization using radioimmunoscintigraphy. The patient presents to a nuclear medicine or outpatient radiology center on the scheduled day. A multidisciplinary team including the ordering oncologist or surgeon, a nuclear medicine physician, a radiopharmacist, and a certified radiologic technologist coordinate care. The radiopharmacist prepares A4642 (Indium-111 satumomab pendetide) in the appropriate activity (up to 6 millicuries) and documents lot and dose. The nuclear medicine physician verifies patient identity, reviews recent therapies and allergy history, and obtains informed consent when required. The tracer is administered intravenously under standard sterile technique. Imaging is typically performed at specified time points post-injection (commonly 24–48 hours) using single-photon emission computed tomography (SPECT) with or without SPECT/CT to localize antigen-expressing tumors. Post-procedure monitoring includes assessment for acute infusion reactions and documentation of administered dose, activity, and any immediate adverse events. Results are interpreted by the nuclear medicine physician and communicated to the referring oncologist or surgeon for staging, restaging, or surgical planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Procedure or service furnished without reportable modifiers |