Summary & Overview
HCPCS A9542: Indium In-111 Ibritumomab Tiuxetan, Diagnostic Study Dose
HCPCS Level II code A9542 denotes administration of Indium In-111 ibritumomab tiuxetan as a diagnostic, per study dose, up to 5 millicuries. The code is used to report the imaging dose needed to evaluate biodistribution of a therapeutic radioimmunoconjugate prior to proceeding with radiotherapeutic treatment. Nationally, accurate reporting of this code supports appropriate tracking of high-cost nuclear medicine services, quality assurance for therapeutic planning, and payer adjudication for diagnostic radiopharmaceutical procedures.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise synthesis of clinical context for use of the diagnostic Indium In-111 study, payer coverage patterns and benchmarks where available, coding and billing considerations tied to service location, and policy or reimbursement updates relevant to radiopharmaceutical diagnostic dosing. The publication clarifies typical sites of service and the service type to aid billing, clinical documentation, and administrative workflows.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes is noted elsewhere in the full publication. The focus here is national clinical and billing context for HCPCS Level II code A9542 and what stakeholders should know about reporting this diagnostic radiopharmaceutical dose.
Billing Code Overview
HCPCS Level II code A9542 describes Indium In-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries. This code represents a nuclear medicine diagnostic radiopharmaceutical dose used to image and assess biodistribution of the therapeutic radioimmunoconjugate prior to treatment.
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Service type: Diagnostic radiopharmaceutical administration for imaging/biodistribution study
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Typical site of service: Hospital outpatient departments or outpatient nuclear medicine/infusion centers where radiopharmaceutical imaging studies are performed
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with relapsed or refractory CD20-positive B-cell non-Hodgkin lymphoma being evaluated for radioimmunotherapy planning and biodistribution assessment. The patient presents to an outpatient nuclear medicine or infusion clinic after hematology/oncology consultation. Prior to therapeutic administration of yttrium-90 ibritumomab tiuxetan, a diagnostic imaging dose of A9542 (Indium-111 ibritumomab tiuxetan, up to 5 millicuries) is administered to assess biodistribution, tumor targeting, and normal-organ uptake.
The clinical workflow: the patient undergoes baseline labs (CBC, renal and hepatic panels) and recent imaging review. On day of diagnostic study, the radiopharmacy dispenses A9542 and verifies activity. The nuclear medicine physician or authorized prescriber obtains informed consent and documents indication (e.g., recurrent follicular lymphoma). The diagnostic radiopharmaceutical is administered intravenously in the nuclear medicine department. Serial planar and SPECT/CT imaging is performed over the next 24–72 hours per institutional protocol to confirm tumor targeting and rule out unexpected biodistribution. Imaging and report determine eligibility for subsequent therapeutic dosing with Y-90 ibritumomab tiuxetan. The encounter is typically performed in an outpatient nuclear medicine or ambulatory infusion center, with coordination between hematology/oncology, nuclear medicine, and radiopharmacy teams.
Coding Specifications
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