Summary & Overview
HCPCS Level II A9537: Technetium tc-99m Mebrofenin, Diagnostic, Per Study Dose
HCPCS Level II code A9537 designates technetium tc-99m mebrofenin used for diagnostic hepatobiliary imaging, billed per study dose up to 15 millicuries. This nuclear medicine radiopharmaceutical code is relevant nationally for hospital outpatient departments, ambulatory imaging centers, and nuclear medicine facilities involved in evaluating gallbladder function and hepatobiliary excretion. The code matters because it identifies the radiopharmaceutical agent and dose for claims processing, utilization monitoring, and clinical documentation tied to hepatobiliary diagnostic services.
Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service setting, typical payer coverage considerations, and the types of administrative benchmarks commonly associated with radiopharmaceutical billing. The publication outlines common modifiers and coding elements for claim submission where available, highlights areas where policy updates commonly occur (for example, coverage criteria and dosing limits), and summarizes the clinical indications that drive utilization of this radiopharmaceutical.
Data not available in the input is noted where payer-specific rates, utilization benchmarks, and associated taxonomies or ICD-10 lists would normally appear.
Billing Code Overview
HCPCS Level II code A9537 represents technetium tc-99m mebrofenin administered for diagnostic hepatobiliary imaging, billed per study dose up to 15 millicuries. The service is a nuclear medicine diagnostic radiopharmaceutical study used to evaluate gallbladder function and hepatobiliary excretion.
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Service type: Diagnostic nuclear medicine radiopharmaceutical study
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Typical site of service: Hospital outpatient department, ambulatory imaging center, or nuclear medicine facility
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred to nuclear medicine for evaluation of hepatobiliary function and suspected biliary obstruction or acute cholecystitis. The clinician orders a technetium Tc-99m mebrofenin hepatobiliary (HIDA) study using billing code A9537 for a diagnostic radiopharmaceutical dose (up to 15 millicuries). The patient arrives to an outpatient imaging center or hospital nuclear medicine department, is screened for pregnancy and recent opioid use, and an intravenous line is placed. The radiopharmaceutical A9537 is administered intravenously and planar or SPECT imaging is acquired over the liver, biliary tree, gallbladder, and small bowel according to the study protocol. Imaging acquisition and interpretation are performed by a nuclear medicine physician or radiologist, with technologist preparation and injection documentation. Typical clinical indications include right upper quadrant pain, suspected acute cholecystitis, evaluation of biliary leak, assessment of biliary atresia in pediatrics, or assessment of bile duct patency after surgery. The typical site of service is an outpatient nuclear medicine department or hospital imaging center; inpatient studies are performed at the bedside or in the hospital’s nuclear medicine unit when clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |