Summary & Overview
HCPCS A9551: Technetium tc-99m Succimer, Diagnostic Dose
HCPCS Level II code A9551 denotes a diagnostic radiopharmaceutical: technetium tc-99m succimer, per study dose up to 10 millicuries. This code is used nationally to identify the drug component of nuclear medicine procedures that require succimer-based imaging agents for evaluation of organ function or pathology. Accurate coding of radiopharmaceuticals supports claims processing, inventory tracking, and clinical documentation for diagnostic imaging services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find national benchmarks for billing and coverage practices, common clinical contexts where the agent is used, and policy or coding considerations relevant to payers and providers. The report outlines service-line placement for radiopharmacy and nuclear medicine departments and typical sites of service such as hospital outpatient imaging centers and freestanding nuclear medicine clinics.
This summary provides clinicians, billing staff, and policy analysts with a concise reference to the clinical role of A9551, payer coverage landscape, and the operational contexts where the code is applied. Data not available in the input will be explicitly noted in relevant sections.
Billing Code Overview
HCPCS Level II code A9551 represents Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries. This code describes a radiopharmaceutical dose used for diagnostic nuclear medicine studies where technetium-labeled succimer is administered and imaged to evaluate specific organ function or pathology.
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Service type: Diagnostic radiopharmaceutical administration for nuclear medicine imaging
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Typical site of service: Hospital outpatient departments, hospital imaging centers, freestanding nuclear medicine clinics, and authorized radiopharmacies that prepare and dispense radiopharmaceuticals
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric patient referred for a radionuclide renal scan using technetium Tc-99m succimer to evaluate differential renal function, suspected acute or chronic renal obstruction, renal cortical scarring, or vesicoureteral reflux. The patient arrives at an outpatient nuclear medicine department or hospital radiology/nuclear medicine suite. After verification of identity, allergy history, and renal function, IV access is obtained. The radiopharmacy supplies a single diagnostic study dose of A9551 (technetium tc-99m succimer, per study dose, up to 10 millicuries). The technologist administers the radiotracer, and dynamic imaging is performed with gamma camera acquisition over the kidneys; delayed static images may follow. A board-certified nuclear medicine physician or radiologist interprets the images and issues a report documenting differential renal perfusion, function, drainage, and any evidence of obstruction or scarring. Common clinical indications include flank pain with suspected obstruction, evaluation of renal function prior to nephrotoxic therapy or surgery, recurrent urinary tract infections in children to assess scarring, and follow-up of partial renal transplant perfusion. Typical site of service: outpatient nuclear medicine department, hospital outpatient radiology, pediatric radiology, or inpatient hospital imaging when clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |