Summary & Overview
HCPCS A9507: Indium In-111 Capromab Pendetide, Diagnostic
HCPCS Level II code A9507 represents Indium In-111 capromab pendetide administered as a diagnostic radiopharmaceutical, per study dose up to 10 millicuries. The code identifies a specialized nuclear medicine agent used to localize prostate cancer recurrence or metastatic disease and is relevant for facilities that provide oncologic imaging and radiopharmaceutical services. Nationally, this code matters because it affects billing for high-cost, low-volume diagnostic agents and ties into coverage policies for advanced oncologic imaging.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find an overview of where this service is typically performed (outpatient radiology/nuclear medicine), how the code is described for billing purposes, and the typical clinical context in which the agent is used. The publication also summarizes common modifiers associated with the service line and highlights what information is available and what is not included in the input data. Benchmarks, policy updates, and payer-specific coverage details are addressed where available. This national-level summary is intended to inform clinicians, billing professionals, and policy analysts about coding, clinical use, and payer relevance for HCPCS Level II code A9507.
Billing Code Overview
HCPCS Level II code A9507 describes Indium In-111 capromab pendetide, a diagnostic radiopharmaceutical supplied per study dose, up to 10 millicuries. This agent is used to localize prostate cancer recurrence or metastatic disease by targeting prostate-specific membrane antigen-related epitopes and delivering a radiolabeled imaging tracer for nuclear medicine scans.
Service Type: Diagnostic radiopharmaceutical administration and imaging study
Typical Site of Service: Outpatient hospital radiology/nuclear medicine department or freestanding imaging center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult male with rising prostate-specific antigen (PSA) after definitive therapy (radical prostatectomy or radiation) or with suspected recurrent or metastatic prostate cancer. The patient is referred by a urologist or medical oncologist for a diagnostic nuclear medicine imaging study using A9507 (Indium In-111 capromab pendetide) to localize prostate cancer antigen expression within the pelvis and regional lymph nodes. Clinical workflow: the patient arrives to an outpatient nuclear medicine or radiology department; informed consent and allergy screening are completed; intravenous access is obtained; the radiopharmaceutical Indium-111 capromab pendetide is administered per protocol (up to 10 millicuries); imaging is scheduled at appropriate post-injection time points (commonly 48–72 hours) for planar and single-photon emission computed tomography (SPECT) or SPECT/CT acquisition; images are reviewed by a nuclear medicine physician; a formal report is generated and communicated to the referring urologist/oncologist for management planning. Typical site of service: outpatient hospital radiology/nuclear medicine department or freestanding imaging center. Typical patient scenario: post-prostatectomy patient with biochemical recurrence (rising PSA) undergoing targeted imaging to evaluate for locoregional nodal disease before salvage therapy planning.
Coding Specifications
| Modifier | Description | When to Use |
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