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

HCPCS Level II code A9540 represents a diagnostic radiopharmaceutical: Technetium tc-99m macroaggregated albumin (MAA), per study dose up to 10 millicuries. This agent is commonly used for lung perfusion imaging, including ventilation-perfusion assessments that inform diagnosis and management of pulmonary embolism and other perfusion abnormalities. As a billable supply, A9540 captures the material component of the nuclear medicine study and is relevant for accurate cost reporting and procedure claims.

Key payers in the national context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical use and site-of-service considerations, payer coverage patterns, typical billing modifiers and claim line practices, and related coding considerations for nuclear medicine imaging workflows. The publication highlights common billing scenarios where A9540 appears on claims, how it interacts with technical and professional components of imaging services, and typical documentation elements that support medical necessity.

This analysis is intended to inform coding, revenue cycle, and clinical teams about where A9540 fits in imaging service lines, what to expect from major payers, and which operational checkpoints influence correct billing and reimbursement. Data not available in the input will be noted where applicable.

Billing Code Overview

HCPCS Level II code A9540 describes Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries. This item is a radiopharmaceutical diagnostic agent used in nuclear medicine studies that evaluate pulmonary perfusion, typically as part of a ventilation-perfusion (V/Q) scan or other lung perfusion imaging procedures.

Service Type: Diagnostic radiopharmaceutical administration for nuclear medicine imaging

Typical Site of Service: Hospital outpatient radiology/nuclear medicine department or outpatient imaging center

Clinical Context

A typical patient is an adult referred for a ventilation–perfusion (V/Q) scintigraphy or lung perfusion scan to evaluate pulmonary embolism, chronic thromboembolic pulmonary hypertension, preoperative assessment for lung resection, or assessment of regional pulmonary perfusion. The patient arrives at a nuclear medicine department in an outpatient imaging center or hospital radiology/nuclear medicine suite. After identification and consent, a technologist confirms indications and allergies, reviews recent contrast studies or anticoagulation status, and prepares the radiopharmaceutical. A dose of Technetium Tc-99m MAA (up to 10 millicuries per study dose, billed as A9540) is drawn under radiation safety protocols and injected intravenously. Imaging is performed with a gamma camera to obtain planar and/or SPECT images of pulmonary perfusion. A nuclear medicine physician interprets the study, generates a report, and documents findings and the injected activity. The technologist documents lot number, activity administered, route, time, and any complications. Typical sites of service are outpatient hospital radiology departments, freestanding imaging centers, and inpatient hospital units when clinically indicated.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting the physician interpretation separate from the technical service provided by the facility/technologist.

Taxonomy Code	Specialty	Notes
`2086P0202X`	Nuclear Medicine Physician	Interprets radiopharmaceutical perfusion imaging and provides written report.
`2085R0201X`	Diagnostic Radiology	Often reads or co-manages nuclear pulmonary imaging in radiology departments.
`3336S0301X`	Nuclear Medicine Technologist	Prepares and administers `Technetium Tc-99m MAA`, performs image acquisition.
`364SP0800X`	Pulmonology	Orders the study for evaluation of pulmonary embolism or pulmonary vascular disease.
`207RC0000X`	Emergency Medicine	May request and coordinate urgent perfusion imaging for acute suspected PE in the ED setting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I26.9`	Pulmonary embolism without acute cor pulmonale	Primary indication for lung perfusion imaging when CT pulmonary angiography is contraindicated or nondiagnostic.
`I26.99`	Other pulmonary embolism without acute cor pulmonale	Alternative PE coding covering variants of embolic disease evaluated with perfusion imaging.
`I27.24`	Chronic pulmonary embolism	Used when assessing chronic thromboembolic disease and regional perfusion abnormalities.
`I27.89`	Other specified pulmonary heart diseases	Employed for evaluation of pulmonary vascular causes of perfusion defects when broader pulmonary vascular pathology is considered.
`Z90.2`	Acquired absence of lung (e.g., after lobectomy or pneumonectomy)	Preoperative or postoperative perfusion assessment to evaluate remaining lung function and surgical planning.
`R06.02`	Shortness of breath	Symptom indication prompting evaluation for pulmonary embolism or other perfusion impairment.
`J98.4`	Other disorders of lung not elsewhere classified	Used when nonspecific pulmonary conditions require perfusion assessment as part of diagnostic workup.
`Z46.3`	Encounter for attention to tracheostomy	Included when perfusion assessment is needed in complex pulmonary management scenarios involving airway support.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`71045`	Radiologic examination, chest, single view, frontal; performed when chest radiographs are indicated as initial imaging for pulmonary symptoms prior to or concurrent with nuclear study.	Chest x-ray is commonly obtained prior to V/Q imaging to evaluate for alternate causes and to interpret perfusion defects.
`78582`	Pulmonary ventilation or perfusion study, quantitative, planar with report	Used for quantification of regional pulmonary perfusion; may be billed in conjunction with `A9540` depending on payer rules and whether ventilation or additional quantitative perfusion imaging is performed.
`78803`	Nuclear medicine, lung perfusion (including ventilation if performed), planar; perfusion only	Represents the nuclear medicine imaging procedure for lung perfusion and is commonly reported alongside the radiopharmaceutical supply code `A9540`.
`78999`	Unlisted diagnostic nuclear medicine procedure	Used when a specific imaging protocol or a novel quantitative calculation related to perfusion is performed that does not map to an established CPT code.
`71046`	Radiologic examination, chest, 2 views	Alternate chest radiograph code if two views are obtained to aid interpretation of the perfusion study.

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Summary & Overview