Summary & Overview
HCPCS A9527: Iodine I-125 Sodium Iodide Therapeutic, per mCi
HCPCS Level II code A9527 designates Iodine I-125 sodium iodide solution for therapeutic use, billed per millicurie. This code captures the radioisotope component used in targeted radiation treatments, frequently employed in oncology and select thyroid therapies. Nationally, accurate coding for radiopharmaceuticals like A9527 is important for consistent claims processing, inventory management, and cost reporting for facilities administering radioactive therapies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical context of I-125 therapeutic use, the typical sites of service where claims for A9527 arise, and the payer landscape addressed. The publication outlines common billing considerations tied to radiopharmaceuticals, benchmark and reimbursement framing where available, and relevant policy or coverage touchpoints that affect national utilization and billing practices.
This summary provides operational clarity for coding professionals, revenue cycle staff, and facility managers seeking a national-level reference on A9527, focusing on billing characterization, payer coverage scope, and clinical service context. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code A9527 describes Iodine I-125, sodium iodide solution, therapeutic, priced per millicurie. This item represents a radioactive therapeutic agent used to deliver targeted radiation doses for conditions treated with I-125, typically in oncology and certain thyroid therapies.
Service type: Therapeutic radiopharmaceutical administration
Typical site of service: Hospital outpatient departments, ambulatory surgery centers, and specialized nuclear medicine or radiation oncology clinics.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with differentiated thyroid carcinoma is evaluated for adjuvant radioiodine therapy. The oncology and nuclear medicine teams determine therapeutic dosing of radioactive iodine I-125 (sodium iodide) to treat residual thyroid tissue or metastatic disease. The patient presents to an outpatient nuclear medicine or hospital-based radiation therapy suite after appropriate pre-procedure preparation, which includes thyroid hormone withdrawal or recombinant human TSH stimulation, pregnancy testing for women of childbearing potential, informed consent, and baseline labs and imaging (thyroid ultrasound, diagnostic whole-body scan or PET/CT as indicated).
On the day of service the nuclear medicine physician documents the prescribed activity in millicuries, verifies patient identity and pregnancy status, prepares and dispenses A9527 (iodine I-125 sodium iodide solution, therapeutic, per millicurie) using calibrated dose preparation procedures in a licensed radiopharmacy or authorized nuclear medicine department, and administers the oral solution or capsule. Post-administration instructions include radiation safety precautions, substance handling, and schedule for follow-up imaging or thyroglobulin monitoring. Typical sites of service are outpatient hospital radiology/nuclear medicine departments, freestanding radiopharmacies for dispensing, and inpatient hospital units when inpatient therapy is required.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no special circumstance applies to the service billing for A9527 |
22 | Increased procedural services | Use when complexity of dose preparation or administration substantially increases resource use beyond typical practice |
23 | Unusual anesthesia | Rarely applicable; use if unusual anesthesia unrelated to the procedure is required during administration |
26 | Professional component | Use when billing only the professional component of a service associated with radiopharmaceutical administration |
52 | Reduced services | Use when a reduced dose or abbreviated administration occurred for clinical reasons |
53 | Discontinued procedure | Use if therapy was initiated but discontinued before completion due to patient reaction or safety concern |
62 | Two surgeons | Use when two qualified physicians with distinct roles are required for a complex therapeutic administration |
80 | Assistant surgeon | Use when an assistant surgeon provides documented assistance during a surgical component related to therapy |
82 | Assistant surgeon (when qualified resident not available) | Use when an assistant surgeon is required and a qualified resident is not available |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services | Use when services associated with preparation or administration are provided by an advanced practice clinician under applicable payor rules |
QX | CRNA service with non-CRNA anesthetist | Use when a certified registered nurse anesthetist provides anesthesia-related care in conjunction with this service (if anesthesia used) |
QY | CRNA service without medical direction by a physician | Use when CRNA provides the anesthesia care without physician medical direction |
TC | Technical component | Use when billing only the technical component (radiopharmacy preparation, dispensing, equipment) for A9527 |
QK | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals | Use in rare cases when anesthesia is medically directed for concurrent procedures related to administration |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
3336C0001X | Nuclear Medicine Physician | Primary specialty responsible for prescribing, dosing, and oversight of therapeutic radiopharmaceutical administration |
2085P0200X | Radiation Oncology | Often involved in multidisciplinary planning and follow-up for radiotherapeutic management |
174400000X | Radiology | Provides imaging guidance, dosimetry correlation, and procedural support in hospital outpatient departments |
363L00000X | Pharmacy | Nuclear pharmacist or radiopharmacist responsible for preparation, calibration, and dispensing of A9527 |
363A00000X | Clinical Pharmacist | Clinical pharmacist involved in dosing verification, medication safety, and counseling |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C73 | Malignant neoplasm of thyroid gland | Primary indication for therapeutic radioactive iodine to ablate residual thyroid tissue or treat metastases |
E06.3 | Chronic lymphocytic thyroiditis (Hashimoto) | May coexist with differentiated thyroid disease; impacts thyroid function management before therapy |
E05.90 | Thyrotoxicosis, unspecified without thyrotoxic crisis or storm | Subacute management of hyperthyroid states may precede or follow radioiodine therapy decisions |
C77.0 | Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck | Regional nodal metastasis from thyroid carcinoma that may be treated or monitored with radioiodine therapy |
C79.1 | Secondary malignant neoplasm of lung | Distant metastasis from thyroid cancer where radioiodine therapy may be indicated if radioiodine-avid |
D09.3 | Carcinoma in situ of thyroid | Pre-malignant or early lesions occasionally considered in multidisciplinary management pathways |
Z85.850 | Personal history of malignant neoplasm of thyroid | Relevant for surveillance and consideration of repeat radioiodine therapy in recurrent disease |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
78800 | Radiopharmaceutical therapy administration; unsealed radiopharmaceutical, therapeutic, per single administration | Frequently billed for the administration procedure when a therapeutic radiopharmaceutical dose such as A9527 is given orally or intravenously |
78120 | Radioactive iodine uptake, diagnostic | Performed before or after therapy to assess iodine uptake and guide therapeutic dosing decisions |
79005 | Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent, single study; this code group includes imaging procedures related to therapeutic agents | Used for diagnostic whole-body or targeted imaging studies associated with planning or post-therapy assessment |
99213 | Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes | Used for pre-procedure evaluation, informed consent, and routine follow-up counseling related to therapy |
99070 | Supplies and materials (e.g., wipes, dressings), used during the procedure, when not included in the service | May be used to report additional non-covered supply costs associated with preparation or administration of the radiopharmaceutical |