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    OpenPayerBilling CodesAdministrative, Miscellaneous and InvestigationalHCPCS hcpcs-a9539-technetium-tc-99m-pentetate-diagnostic
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    HCPCS A9539: Technetium Tc-99m Pentetate, Diagnostic, Per Study Dose

    HCPCS Level II code A9539 describes a diagnostic nuclear medicine radiopharmaceutical, technetium tc-99m pentetate, billed per study dose (up to 25 millicuries) used for imaging procedures; the service is a diagnostic radiopharmaceutical administration typically performed in an outpatient imaging center or hospital nuclear medicine department for studies requiring cisternography or cerebrospinal fluid imaging.

    For related coverage guidance, see recent payer policy updates: Interferential Stimulation Devices (for home use), Durable Medical Equipment (DME): Tumor Treating Fields (Alternating Electric Field Therapy) Medical Guideline, Durable Medical Equipment (DME): Bone Growth Stimulators Medical Guideline.

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    Clinical & Coding Specifications

    Clinical Context

    A typical adult patient presents to the outpatient nuclear medicine department with a clinical question of cerebrospinal fluid (CSF) leak localization or evaluation of cerebrospinal fluid flow dynamics. The patient has symptoms such as positional headache, clear rhinorrhea suspicious for CSF otorrhea/rhinorrhea, or post-lumbar-puncture headache that has not responded to conservative measures. A radionuclide cisternography study using A9539 (Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries) is ordered by the referring neurologist or neurosurgeon.

    Workflow:

    • Referral and order entry: The referring clinician documents indication (e.g., suspected CSF leak) and relevant ICD-10 diagnosis code on the order.

    • Pre-procedure preparation: The nuclear medicine team obtains informed consent, reviews allergies and recent imaging, and confirms no pregnancy. Intrathecal administration requires sterile lumbar puncture technique performed by an appropriately credentialed clinician (radiologist, neurologist, or neurosurgeon).

    • Procedure: A lumbar puncture is performed under sterile conditions; Technetium tc-99m pentetate is prepared and a study dose (up to 25 mCi) is injected intrathecally. Serial planar and/or SPECT images are acquired over several hours to days to assess CSF flow or detect extra‑cranial tracer leakage.

    • Post-procedure care: The patient is observed per facility protocols for complications (headache, back pain, infection). Imaging results are interpreted by the nuclear medicine physician and correlated with clinical findings for surgical planning or further management.

    Typical site of service: Outpatient nuclear medicine department, hospital radiology / nuclear medicine suite, or ambulatory surgical center if lumbar puncture requires sedation or IR support.

    Typical patient scenario: Adult with suspected spontaneous CSF leak presenting with positional headache and clear nasal drainage, being evaluated after non-diagnostic CT cisternography, referred for radionuclide cisternography using A9539 to localize leak.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    62270Spinal puncture, lumbar, diagnosticPerformed to gain intrathecal access for administration of radiopharmaceutical such as A9539

    78999 | Unlisted diagnostic radiology procedure (nuclear medicine) | Used rarely when a specific nuclear medicine procedure lacks a precise CPT; adjunct to A9539 billing in some facility charge structures

    78306 | Bone imaging, whole body; delayed images | Not directly for CSF but represents other nuclear medicine imaging workflow often grouped in department coding; included here as a departmental related study

    77261 | Therapeutic radiology simulation; basic | Not directly related clinically; Data not available in the input.

    96372 | Therapeutic, prophylactic, or diagnostic injection (specify substance) | Sometimes used for billing intrathecal administration when local payer rules permit adjunct procedural coding

    Note: If specific CPT codes are required by payer policy for procedural components, local billing rules determine whether the lumbar puncture () and nuclear medicine interpretation are billed separately. For facility claims typically represents the radiopharmaceutical supply charge.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    2084N0400XNeurology PhysicianA Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, auton…
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    207P00000XEmergency Medicine PhysicianAn emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
    261QR0401XComprehensive Outpatient Rehabilitation Facility (CORF)Ambulatory Health Care Facilities · Clinic/Center
    207QB0002XObesity Medicine (Family Medicine) PhysicianA physician who specializes in the treatment of obesity demonstrates competency in and a thorough understanding of the treatment of obesity and the ge…
    2255R0406XBlind Rehabilitation Specialist/TechnologistRespiratory, Developmental, Rehabilitative and Restorative Service Providers · Specialist/Technologist
    302F00000XExclusive Provider Organization(1) An EPO is a form of PPO, in which patients must visit a caregiver that is specified on its panel of providers (is a participating provider). If a …

    Related Payer Policy Updates

    Specialty: Durable Medical Equipment (DME)1 / 3

    5 rows

    PolicyPayerEffective Date
    Interferential Stimulation Devices (for home use)Moda Health2026-10-01
    Durable Medical Equipment (DME): Tumor Treating Fields (Alternating Electric Field Therapy) Medical GuidelineWPS Health Insurance2026-10-01
    Durable Medical Equipment (DME): Bone Growth Stimulators Medical GuidelineWPS Health Insurance2026-10-01
    General Durable Medical Equipment (DME) Medical GuidelineWPS Health Insurance2026-10-01
    Prior Authorization for Durable Medical Equipment (DME)Blue Cross Blue Shield - Rhode Island2026-10-01

    Related Codes

    HCPCS-A9150-NON-PRESCRIPTION-DRUGS

    HCPCS Level II A9150: Non-prescription Drugs

    HCPCS-A9152-SINGLE-ORAL-VITAMIN-MINERAL-DOSE

    HCPCS A9152: Single Oral Vitamin/Mineral/Trace Element

    HCPCS-A9153-MULTIVITAMIN-ORAL-PER-DOSE

    HCPCS A9153: Multiple Vitamins, Oral, Per Dose

    HCPCS-A9154-ARTIFICIAL-SALIVA-1ML

    HCPCS Level II A9154: Artificial saliva, 1 ml

    HCPCS-A9155-ARTIFICIAL-SALIVA-30ML

    HCPCS Level II A9155: Artificial Saliva, 30 mL

    HCPCS-A9156-ORAL-MUCOADHESIVE-PER-1ML

    HCPCS Level II A9156: Oral Mucoadhesive, Per 1 ml

    HCPCS-A9180-PEDICULOSIS-TOPICAL-TREATMENT-PATIENT-ADMINISTRATION

    HCPCS Level II A9180: Pediculosis Topical Treatment for Patient/Caretaker

    HCPCS-A9268-PROGRAMMER-TRANSIENT-INGESTED-CAPSULE

    HCPCS Level II A9268: Programmer for Transient Orally Ingested Capsule

    HCPCS-A9269-PROGRAMMABLE-TRANSIENT-ORAL-CAPSULE

    HCPCS Level II A9269: Programmable Orally Ingested Capsule, Per Month

    HCPCS-A9270-NON-COVERED-ITEM-OR-SERVICE

    HCPCS A9270: Non-covered Item or Service

    Showing 1–10 of 138

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    62270
    A9539