A9528 I-131 Diagnostic Capsule HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS A9528: Iodine I-131 Sodium Iodide Capsule, Diagnostic

HCPCS Level II code A9528 denotes diagnostic Iodine I-131 sodium iodide capsules measured per millicurie, a radiopharmaceutical used in nuclear medicine for thyroid uptake studies and diagnostic imaging. Nationally, this code matters because radiopharmaceuticals have distinct ordering, handling, and billing workflows and because reimbursement and coverage policies for diagnostic isotopes affect access to thyroid and related diagnostic 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 clinical context for I-131 diagnostic use, typical sites of service where the agent is provided, and the common administrative considerations tied to this HCPCS Level II code. The publication summarizes national benchmarks and coverage patterns where available, highlights relevant policy updates affecting radiopharmaceutical billing, and outlines billing and service-line implications for hospital outpatient and outpatient clinic settings.

This summary equips billing managers, coding specialists, and clinical leaders with a clear understanding of what HCPCS Level II code A9528 represents, which payers are addressed, and the types of operational and reimbursement issues to consider when scheduling and billing diagnostic I-131 procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA9528HCPCS Level IIradiopharmaceuticalnuclear-medicineiodine-i-131diagnostic-imaginghospital-outpatientbilling

Billing Code Overview

HCPCS Level II code A9528 describes Iodine I-131 sodium iodide capsule(s), diagnostic, per millicurie. This code represents a diagnostic radiopharmaceutical preparation supplied as capsules containing radioactive iodine (I-131) used for diagnostic imaging or uptake studies in nuclear medicine.

Service type: Diagnostic radiopharmaceutical administration / nuclear medicine diagnostic agent

Typical site of service: Hospital outpatient departments, nuclear medicine clinics, and specialized radiology or endocrinology outpatient centers

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult referred to nuclear medicine for a diagnostic evaluation of thyroid function or anatomy using Iodine I-131 sodium iodide capsules administered by activity (per millicurie). Common indications include differentiation of thyroid uptake in hyperthyroidism, assessment of residual thyroid tissue after thyroidectomy, or localization of functioning thyroid tissue when radioactive iodine whole-body scanning is planned. The clinical workflow: the patient presents to an outpatient nuclear medicine or radiopharmacy clinic after an endocrinology or primary care referral. Pre-procedure checks include pregnancy test for women of childbearing potential, medication and dietary restrictions (e.g., withholding interfering thyroid medications and recent iodine exposure), and informed consent. A radiopharmacist dispenses the prescribed activity of I-131 in capsule form (billed per millicurie using A9528). The capsule is administered orally under supervised conditions. After administration, timed uptake measurements are obtained (typically at 4–6 hours and 24 hours) with a gamma probe or gamma camera to calculate thyroid uptake and perform imaging as indicated. Radiation safety instructions and written precautions are provided. Results are interpreted by a nuclear medicine physician or endocrinologist and documented in the radiology/nuclear medicine report for treatment planning or diagnostic confirmation.

Coding Specifications

Modifier	Description	When to Use

HCPCS Level II A9547: Indium In-111 Oxyquinoline, Diagnostic, per 0.5 millicurie

HCPCS-A9698-NON-RADIOACTIVE-CONTRAST-PER-STUDY

HCPCS A9698: Non-Radioactive Contrast Imaging Material, Per Study

HCPCS-A9540-TECHNETIUM-TC-99M-MACROAGGREGATED-ALBUMIN-LUNG-PERFUSION

HCPCS A9540: Technetium Tc-99m MAA for Lung Perfusion Imaging

HCPCS-A9502-TECHNETIUM-TC-99M-TETROFOSMIN-DIAGNOSTIC

HCPCS A9502: Technetium tc-99m tetrofosmin, Diagnostic Per-Study Dose

HCPCS-A9543-YTTRIUM-Y-90-IBRITUMOMAB-TIUXETAN-THERAPEUTIC-DOSE

HCPCS Level II A9543: Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic Dose

HCPCS-A9300-EXERCISE-EQUIPMENT-DURABLE-MEDICAL-EQUIPMENT

HCPCS A9300: Exercise Equipment

HCPCS-A9508-IODINE-I131-IOBENGUANE-DIAGNOSTIC-0-5-MCI

HCPCS Level II A9508: Iodine I-131 iobenguane sulfate, Diagnostic

HCPCS-A9596-GALLIUM-GA-68-GOZETOTIDE-DIAGNOSTIC-ILLUCCIX-1-MILLICURIE

HCPCS A9596: Gallium Ga-68 Gozetotide (Illuccix), Diagnostic, 1 mCi

HCPCS-A9150-NON-PRESCRIPTION-DRUGS

HCPCS Level II A9150: Non-Prescription Drugs

HCPCS-A9557-TECHNETIUM-BICISATE-DIAGNOSTIC-BRAIN-IMAGING

HCPCS A9557: Technetium tc-99m bicisate, Diagnostic Brain Imaging

Showing 1–10 of 138

Taxonomy Code	Specialty	Notes
`208F00000X`	Nuclear Medicine Physician	Primary interpreting and overseeing specialty for `I-131` diagnostic procedures and uptake imaging.
`207L00000X`	Radiologist	Often interprets nuclear medicine imaging and provides consultative reports.
`208000000X`	Internal Medicine / Endocrinology	Endocrinologists order studies, interpret results in clinical context, and manage follow-up.
`3336S0005X`	Radiopharmacist	Prepares and dispenses radiopharmaceuticals, ensures activity dosing and regulatory compliance.
`367A00000X`	Nurse Practitioner	Performs patient education, consents, and some clinical coordination in outpatient nuclear medicine.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E05.90`	Thyrotoxicosis, unspecified without thyrotoxic crisis or storm	Common indication to assess thyroid uptake and differentiate causes of hyperthyroidism using diagnostic `I-131`.
`E04.1`	Nontoxic single thyroid nodule	Used when evaluating functional status and uptake characteristics of a solitary thyroid nodule.
`E04.8`	Other nontoxic goiter	Employed when assessing diffuse or multinodular goiter function with uptake studies.
`E89.0`	Postprocedural hypothyroidism	Applied when evaluating residual or recurrent functioning thyroid tissue after thyroid surgery.
`C73`	Malignant neoplasm of thyroid gland	Diagnostic `I-131` low-activity scans may be used in postoperative surveillance planning prior to therapeutic radioiodine.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78015`	Thyroid uptake and imaging, static imaging, single study; includes quantification	Performed for measurement of thyroid uptake after `I-131` capsule administration; imaging component commonly billed alongside radiopharmaceutical supply and administration.
`78016`	Thyroid uptake and imaging, multiple static images with quantitative measurement(s)	Used when multiple time-point images and quantitative uptake calculations are obtained following `I-131` diagnostic dosing.
`78800`	Radiopharmaceutical therapy administration (e.g., systemic)	Billed when radiopharmaceuticals are administered; for diagnostic low‑activity `I-131`, related administration codes for diagnostic nuclear medicine procedures are used in conjunction with supply code `A9528`.
`99070`	Supplies and materials (except spectacles), provided by physician over and above those usually included with the service	May be used for additional non-covered supplies related to administration and patient radiation shielding materials when applicable.
`80500`	Thyroid uptake and/or imaging interpretation, single determination	Physician interpretation/consultation for uptake measurements often billed in conjunction with imaging supply and technical components.

OpenPayer