A9554 I-125 Iothalamate HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS A9554: Iodine I-125 Sodium Iothalamate, Diagnostic Per-Dose

HCPCS Level II code A9554 represents iodine I-125 sodium iothalamate supplied for diagnostic use, billed per study dose up to 10 microcuries. As a specialized radiopharmaceutical, this code is relevant to nuclear medicine imaging and renal function studies, and its use affects billing for outpatient imaging centers, hospital radiology departments, and specialty clinics that handle radiolabeled tracers. Nationally, accurate coding of radiopharmaceuticals like A9554 supports appropriate claims processing, inventory tracking, and compliance with radiation safety billing practices.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, common billing modifiers, and payer coverage patterns where available. The publication also outlines benchmark considerations and policy-relevant points affecting reimbursement workflows for radiopharmaceutical diagnostic studies.

This summary delivers practical reference material for coding and billing teams, revenue cycle stakeholders, and clinical program managers who oversee nuclear medicine services, enabling clearer alignment between clinical use and claims reporting.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA9554HCPCS Level IIradiopharmaceuticalnuclear medicinerenal function studydiagnostic imagingiodine I-125sodium iothalamatestudy dose

Billing Code Overview

HCPCS Level II code A9554 describes iodine I-125 sodium iothalamate used for diagnostic studies, billed per study dose, up to 10 microcuries. This product is employed as a radiopharmaceutical diagnostic agent when a labeled iothalamate tracer is needed to evaluate renal function or perform radiolabeled agent studies.

Service type: Diagnostic radiopharmaceutical administration for nuclear medicine studies
Typical site of service: Hospital outpatient departments, nuclear medicine clinics, and specialized imaging centers equipped for radiopharmaceutical handling and diagnostic renal studies

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult referred for a diagnostic renal nuclear medicine clearance study using iodinated radiopharmaceuticals. A 62-year-old patient presents with suspected decreased renal function after laboratory creatinine rise and asymmetric kidney size on ultrasound. The ordering nephrologist requests a quantitative renal cortical scintigraphy study using Iodine I-125 sodium iothalamate to assess glomerular filtration rate (GFR) per study dose up to 10 microcuries. The clinical workflow: the patient checks in at an outpatient nuclear medicine or radiology clinic; technologist verifies indications, allergies, and pregnancy status; baseline vitals are obtained. The radiopharmacy prepares the A9554 study dose and documents activity. The technologist administers the radiopharmaceutical intravenously, performs timed imaging and sample collection per protocol, and records injection time and residual dose. Images and quantitative measurements are processed; the interpreting nuclear medicine physician (or radiologist) reviews results and issues a report to the referring provider. Billing uses HCPCS Level II code A9554 for the study dose, alongside facility and professional services billed per usual CPT and institutional billing practice.

Coding Specifications

Modifier	Description	When to Use
`22`

HCPCS A9300: Exercise Equipment

HCPCS-A9561-TECHNETIUM-TC-99M-OXIDRONATE-BONE-IMAGING

HCPCS A9561: Technetium tc-99m Oxidronate for Bone Imaging

HCPCS-A9999-MISC-DME-SUPPLY-ACCESSORY

HCPCS A9999: Miscellaneous DME Supply or Accessory

HCPCS-A9615-PEGULICIANINE-INJECTION-1MG

HCPCS A9615: Injection, pegulicianine, 1 mg

HCPCS-A9603-PAFOLACIANINE-INJECTION-IMAGING-AGENT

HCPCS A9603: Injection of Pafolacianine, 0.1 mg

HCPCS-A9590-IOBENGUANE-IODINE-I-131-1-MILLICURIE

HCPCS A9590: Iodine I-131 Iobenguane, 1 millicurie

HCPCS-A9586-FLORBETAPIR-F18-PET-AMYLOID-IMAGING

HCPCS A9586: Florbetapir F18 Diagnostic PET Dose, Up to 10 mCi

HCPCS-A9575-GADOTERATE-MEGLUMINE-INJECTION-MRI-CONTRAST

HCPCS Level II A9575: Injection, Gadoterate Meglumine, 0.1 ml

HCPCS-A9589-HEXAMINOLEVULINATE-INSTILLATION-100MG

HCPCS A9589: Hexaminolevulinate Instillation, 100 mg

HCPCS-A9279-MONITORING-DEVICE-STAND-ALONE-OR-INTEGRATED

HCPCS A9279: Monitoring Feature or Device, Stand‑Alone or Integrated

Showing 1–10 of 138

Taxonomy Code	Specialty	Notes
`208000000X`	Diagnostic Radiology	Most nuclear medicine studies are interpreted by diagnostic radiologists with nuclear medicine training.
`2085N0007X`	Nuclear Medicine	Nuclear medicine physicians commonly oversee radiopharmaceutical preparation, administration, and interpretation.
`334600000X`	Nephrology	Nephrologists commonly order quantitative renal clearance studies to assess kidney function.
`363L00000X`	Clinical Laboratory	Clinical laboratory personnel may perform timed plasma/urine assays associated with clearance testing.
`174400000X`	Physician Assistant	Physician assistants often assist in pre-procedure evaluation and patient management in outpatient settings.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78800`	Radiopharmaceutical therapy and/or imaging, diagnostic, non-specific; planar, single study	May be used for planar renal scintigraphy imaging performed alongside administration of `A9554` when planar imaging is billed separately.
`78700`	Quantitative renal scintigraphy (e.g., functional renal imaging)	Commonly performed in conjunction with radiopharmaceutical administration to assess renal function and drainage; complements the `A9554` dose billing.
`36415`	Collection of venous blood by venipuncture	Used when timed blood samples are required for plasma clearance measurements associated with the study dose.
`99000`	Handling and/or conveyance of specimen for transfer from the office to a laboratory	May apply if specimen handling or courier services are billed related to plasma/urine samples needed for the clearance study.
`93010`	Interpretation and report only (electrocardiogram)	Not directly related but commonly billed in pre-procedure clearance contexts when an ECG is separately performed; include only when actually performed.

OpenPayer