A9544 I-131 tositumomab HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS A9544: Iodine I-131 tositumomab, Diagnostic Study Dose

HCPCS Level II code A9544 denotes a diagnostic dose of Iodine I-131 tositumomab, a radiopharmaceutical used in nuclear medicine to assess biodistribution and disease characteristics prior to or alongside therapeutic planning. This code matters nationally because radiopharmaceutical diagnostic procedures inform cancer staging, treatment selection, and safe use of subsequent therapeutic radioimmunotherapy. Appropriate coding ensures accurate capture of specialized diagnostic services that have implications for care pathways and reimbursement of high-cost imaging agents.

Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for A9544, typical sites of service, and national implications for coverage and billing practice. The publication covers benchmarks for utilization and reimbursement where available, summaries of payer coverage patterns and prior authorization trends, and policy updates affecting radiopharmaceutical diagnostic services. Clinical considerations for safe administration and documentation elements needed for billing are summarized to support coding accuracy. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA9544HCPCS Level IIradiopharmaceuticalnuclear medicinediagnostic imagingIodine I-131tositumomabstudy dosehospital outpatient

Billing Code Overview

HCPCS Level II code A9544 represents Iodine I-131 tositumomab, diagnostic, billed per study dose. This code is used for diagnostic applications of the radiopharmaceutical Iodine I-131 tositumomab, typically administered as a single study dose to evaluate disease characteristics or biodistribution prior to or in conjunction with therapeutic planning.

Service type: Diagnostic radiopharmaceutical study dose

Typical site of service: Hospital outpatient department or nuclear medicine/diagnostic imaging center, where radioactive diagnostic agents are prepared and administered under specialized radiopharmacy and nuclear medicine protocols.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 65-year-old with relapsed or refractory non-Hodgkin B-cell lymphoma being evaluated for radioimmunodiagnostic staging using A9544 (Iodine I-131 tositumomab, diagnostic, per study dose). The multidisciplinary workflow begins in hematology/oncology: the oncologist orders the diagnostic radiolabeled antibody study to assess whole-body disease distribution and antigen expression prior to consideration of therapeutic radioimmunotherapy. On the day of service, the patient presents to an outpatient nuclear medicine or hospital-based radiology department. A nuclear medicine physician or authorized prescriber reviews prior imaging and labs (including thyroid function and pregnancy status), obtains informed consent, and documents indication and target sites. The radiopharmacy prepares and dispenses I-131 tositumomab per protocol; radiation safety and dose verification are completed. The radiopharmaceutical is administered intravenously under nuclear medicine supervision; post-injection imaging (planar and/or SPECT/CT) is performed at protocol-specified time points to document biodistribution and tumor targeting. Imaging and dose report are interpreted by the nuclear medicine physician, with results communicated to the referring oncologist to inform eligibility and planning for potential therapeutic I-131 tositumomab or other targeted treatments. Typical sites of service are outpatient nuclear medicine departments, hospital outpatient imaging centers, or specialized oncology infusion centers with nuclear medicine capability.

Coding Specifications

Modifier	Description	When to Use

HCPCS A9293: Fertility Cycle Tracking Software Application, Monthly

HCPCS-A9150-NON-PRESCRIPTION-DRUGS

HCPCS Level II A9150: Non-Prescription Drugs

HCPCS-A9275-HOME-GLUCOSE-DISPOSABLE-MONITOR-WITH-TEST-STRIPS

HCPCS A9275: Home Glucose Disposable Monitor, Includes Test Strips

HCPCS-A9536-TECHNETIUM-TC-99M-DEPREOTIDE-DIAGNOSTIC

HCPCS A9536: Technetium tc-99m Depreotide, Diagnostic Dose

HCPCS-A9559-COBALT-CO57-CYANOCOBALAMIN-ORAL-DIAGNOSTIC

HCPCS A9559: Cobalt Co-57 Cyanocobalamin Oral Diagnostic Dose

HCPCS-A9595-PIFLUFOLASTAT-F18-PET-RADIOTRACER-1-MILLICURIE

HCPCS A9595: Piflufolastat F-18, Diagnostic Radiopharmaceutical, 1 mCi

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

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

HCPCS-A9272-DISPOSABLE-WOUND-SUCTION-DEVICE-KIT

HCPCS A9272: Disposable Wound Suction Device Kit, Per Item

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

HCPCS A9300: Exercise Equipment

HCPCS-A9615-PEGULICIANINE-INJECTION-1MG

HCPCS A9615: Injection, pegulicianine, 1 mg

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Taxonomy Code	Specialty	Notes
`207RH0000X`	Nuclear Medicine Physician	Interprets imaging, directs radiopharmaceutical administration and safety.
`2085P0200X`	Hematology & Oncology	Orders diagnostic radioimmunoscintigraphy to stage lymphoma and guide therapy.
`363L00000X`	Radiopharmacist	Prepares and verifies the radiolabeled dose according to protocol and radiation safety.
`261QP2300X`	Diagnostic Radiology	May perform or supervise SPECT/CT imaging acquisition and technical aspects.
`363A00000X`	Medical Physicist	Provides dosimetry, radiation safety oversight, and imaging protocol optimization.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C82.90`	Follicular non-Hodgkin lymphoma, unspecified, extranodal and solid organ sites unspecified	Follicular lymphoma is a common B-cell lymphoma type evaluated with radioimmunodiagnostics prior to radioimmunotherapy.
`C83.30`	Diffuse large B-cell lymphoma, unspecified site	Diffuse large B-cell lymphoma may be assessed for antigen targeting and extent of disease with diagnostic radiolabeled antibody imaging.
`C85.80`	Other specified types of non-Hodgkin lymphoma	Other B-cell NHL subtypes that may be evaluated for suitability for I-131 tositumomab therapy.
`C96.2`	Extranodal NK/T-cell lymphoma, nasal type	Although less commonly targeted, extranodal lymphomas may require imaging to determine distribution; included when differential diagnosis warrants.
`Z08`	Encounter for follow-up examination after completed treatment for malignant neoplasm	Post-therapy surveillance scenario where diagnostic radiolabeled antibody imaging is used to evaluate residual or recurrent disease prior to therapeutic decisions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78830`	Radiopharmaceutical localization of tumor; whole body, planar imaging	Commonly used to obtain whole-body planar images after administration of `I-131 tositumomab` to document biodistribution.
`78831`	Radiopharmaceutical localization of tumor; limited (e.g., 1–2 areas), planar imaging	Used when imaging targets limited anatomical regions after diagnostic radiopharmaceutical administration.
`78800`	Radiopharmaceutical localization of tumor; non-imaging (e.g., probe)	Applied when non-imaging localization techniques or counts are used as part of diagnostic evaluation.
`78882`	Radiopharmaceutical localization of tumor; SPECT/CT	Performed when SPECT/CT is acquired after `I-131 tositumomab` injection to provide tomographic localization and anatomic correlation.
`78015`	Therapy administration, radiopharmaceuticals; by infusion or injection	Used in workflow when documenting the actual administration procedure for the diagnostic radiopharmaceutical dose.

`26`	Professional component	Use when billing only the physician interpretation of imaging associated with the diagnostic radiopharmaceutical study.
`TC`	Technical component	Use when billing only the facility technical component (radiopharmacy preparation, administration, imaging equipment).
`59`	Distinct procedural service	Use when the diagnostic radiopharmaceutical service is distinct from other services billed on the same day (e.g., separate imaging study).
`76`	Repeat procedure by same physician	Use if the diagnostic dose and imaging are repeated the same day by the same provider.
`77`	Repeat procedure by another physician	Use if a repeat diagnostic radiopharmaceutical administration/imaging is performed by a different physician.
`Q0`	Investigational clinical service provided in a clinical research study, non-covered	Use when the diagnostic radiopharmaceutical is administered as part of a clinical study designated non-covered.
`Q1`	Investigational clinical service provided in a clinical research study, covered	Use when the diagnostic radiopharmaceutical is part of a covered clinical trial per payor policy.
`JW`	Drug or biological product excluded from coverage under the plan (no replacement)	Use when billing a discarded portion of the radiopharmaceutical is not billable and must be reported as discarded (when applicable by payor rules).
`XE`	Separate encounter, a service that is distinct because it occurred during a separate encounter	Use when the diagnostic study occurred in a distinct encounter from other services on the same date.
`GP`	Services delivered under an outpatient therapy plan of care	Use in facilities where an outpatient therapy plan of care designation is required for imaging or infusion services.

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