Summary & Overview
HCPCS A9504: Technetium Tc-99m Apcitide, Diagnostic, Up to 20 mCi
HCPCS Level II code A9504 denotes technetium tc-99m apcitide, a radiopharmaceutical supplied for diagnostic imaging, billed per study dose up to 20 millicuries. This code is relevant for facilities and suppliers that provide nuclear medicine imaging for evaluation of physiological processes where Tc-99m apcitide is indicated. Nationally, accurate coding of radiopharmaceuticals affects claims adjudication, supply cost accounting, and clinical reporting in imaging services.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and reimbursement policies for radiopharmaceuticals vary across these payers, influencing site-of-service decisions and billing workflows in outpatient imaging centers and hospital-based nuclear medicine departments.
Readers will gain a concise overview of what A9504 represents clinically and operationally, common payer coverage considerations, and the types of benchmarks and policy topics that typically accompany radiopharmaceutical billing analyses. The publication provides context on billing practices, common coding scenarios, and where to look for payer-specific guidance. Data not available in the input for certain items (such as detailed payer fee schedules, associated taxonomies, and ICD-10 pairings) is noted where applicable in other sections.
Billing Code Overview
HCPCS Level II code A9504 represents technetium tc-99m apcitide supplied for diagnostic use, billed per study dose up to 20 millicuries. This product is a radiopharmaceutical used in nuclear medicine procedures to image and evaluate certain physiological processes.
Service type: Diagnostic radiopharmaceutical administration
Typical site of service: Hospital outpatient imaging departments, nuclear medicine suites, and freestanding imaging centers
Clinical & Coding Specifications
Clinical Context
A patient with suspected acute or chronic deep venous thrombosis presents to an outpatient nuclear medicine clinic or hospital imaging department for a technetium tc-99m apcitide venous imaging study. Typical patients are adults with unilateral leg swelling, pain, erythema, or risk factors for thromboembolism (recent surgery, immobilization, malignancy, prior DVT). The ordering provider is often an emergency physician, vascular medicine specialist, or primary care provider. The nuclear medicine team verifies patient identity, assesses pregnancy status, confirms indications and allergies, and obtains IV access. The radiopharmacy dispenses A9504 (Technetium tc-99m apcitide) up to 20 millicuries per study dose. The technologist administers the radiopharmaceutical, performs planar and/or SPECT imaging of the affected limb(s), and documents dose, route, time, and any immediate reactions. A nuclear medicine physician interprets images, generates a report with impression (presence, absence, or indeterminate for venous thrombus), and communicates urgent results to the referring clinician. Billing uses HCPCS A9504 for the apcitide dose and may include facility or professional charges for imaging acquisition and interpretation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |