Summary & Overview
HCPCS A9526: Nitrogen n-13 Ammonia, Diagnostic, Per Study Dose
HCPCS Level II code A9526 designates Nitrogen n-13 ammonia radiopharmaceutical for diagnostic imaging, billed per study dose (up to 40 millicuries). This tracer is used primarily in nuclear cardiology for myocardial perfusion imaging and contributes to evaluation of coronary artery disease and cardiac function. The code matters nationally as hospitals and outpatient imaging centers rely on accurate coding for coverage determinations, billing consistency, and appropriate tracking of high-cost radiopharmaceuticals.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for use of Nitrogen n-13 ammonia, common sites of service, and the payer landscape relevant to utilization and coverage. The publication also summarizes benchmarks and policy considerations relevant to radiopharmaceutical billing, highlights common modifiers used in practice, and outlines where additional documentation and billing attention is typically required.
This summary is intended to provide a concise national view of what A9526 represents, typical settings where the service is delivered, and the payer group commonly involved in coverage and reimbursement decisions. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
HCPCS Level II code A9526 describes Nitrogen n-13 ammonia used for diagnostic imaging, billed per study dose, up to 40 millicuries. The service is a radiopharmaceutical diagnostic study involving administration of the tracer to evaluate myocardial perfusion and related cardiac function.
Service Type: Nuclear medicine radiopharmaceutical diagnostic study
Typical Site of Service: Hospital outpatient imaging department or independent nuclear medicine facility
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with known ischemic cardiomyopathy and exertional chest pain is referred for a PET myocardial perfusion study using nitrogen N-13 ammonia. The patient arrives to an outpatient nuclear cardiology center or hospital-based imaging department after cardiology consultation. An intravenous line is placed, medication review and informed consent are completed, and baseline vitals and ECG are obtained. The technologist administers the A9526 radiopharmaceutical dose (up to 40 millicuries) for rest imaging followed by stress imaging using pharmacologic or exercise stress as clinically indicated. Dynamic and static PET images are acquired, reconstructed, and reviewed by a nuclear cardiologist. The study informs assessment of myocardial perfusion, viability, and coronary artery disease severity to guide downstream management such as revascularization planning or medical therapy adjustments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default billing indicator (no modifier) | When no specific modifier applies to the claim. |
22 | Increased procedural services |