Summary & Overview
HCPCS Level II A9501: Technetium tc-99m teboroxime Diagnostic Study Dose
HCPCS Level II code A9501 denotes a diagnostic radiopharmaceutical study dose of technetium tc-99m teboroxime, an agent historically used in nuclear cardiac perfusion imaging. The code identifies the per-study dose of the radiotracer and is relevant for facility and imaging claims where cardiac perfusion evaluation is performed. Nationally, radiopharmaceutical codes like A9501 are important for accurate reporting of diagnostic imaging resources, inventory management, and payment clarity for imaging services.
Key payers covered 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 A9501, typical sites of service, common claim modifiers associated with radiopharmaceutical administration when available, and notes on payer coverage patterns and coding considerations. The publication provides benchmarks and policy-relevant points that clarify how A9501 is used in practice, highlights potential billing pitfalls, and summarizes recent policy updates affecting radiopharmaceutical reimbursement and reporting.
This national summary is intended to help billing managers, coders, and policy analysts understand the purpose of A9501, where it is commonly applied, and the payer types most likely to be involved in claims for technetium tc-99m teboroxime studies.
Billing Code Overview
HCPCS Level II code A9501 represents Technetium tc-99m teboroxime, diagnostic, per study dose. This code covers a radiopharmaceutical agent used for diagnostic nuclear medicine imaging studies that evaluate cardiac perfusion.
Service Type: Diagnostic radiopharmaceutical administration
Typical Site of Service: Hospital outpatient radiology/nuclear medicine department or independent imaging center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting with exertional chest pain, dyspnea on exertion, or an abnormal resting ECG who requires myocardial perfusion imaging to assess for reversible ischemia. The patient is referred by a cardiologist or primary care physician for a single-photon emission computed tomography (SPECT) perfusion study using technetium Tc-99m teboroxime as the radiopharmaceutical. The clinical workflow includes pre-test screening for contraindications, obtaining informed consent, intravenous access placement, injection of A9501 (technetium tc-99m teboroxime) per study dose, exercise or pharmacologic stress protocol (e.g., treadmill or adenosine/regadenoson), image acquisition at specified time points, image processing, and interpretation by a nuclear medicine physician or cardiologist. Typical sites of service are hospital outpatient imaging departments, freestanding nuclear cardiology centers, and hospital inpatient nuclear medicine suites when inpatient evaluation is indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typically required for the procedure (e.g., complex patient preparation or extended imaging protocol). |