Summary & Overview
HCPCS A9556: Gallium Ga-67 Citrate, Diagnostic, Per Millicurie
HCPCS Level II code A9556 identifies Gallium Ga-67 citrate billed per millicurie for diagnostic nuclear medicine imaging. Radiopharmaceuticals like Ga-67 are used in targeted imaging for infection, inflammation, and certain malignancies; accurate coding for per-millicurie billing affects facility and professional reimbursements and inventory accounting. Nationally, radiopharmaceutical billing influences imaging access, nuclear medicine service lines, and inpatient/outpatient utilization patterns.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code and clinical context, as well as what typical coverage considerations and billing components are relevant for this product-type code. The publication outlines typical sites of service, common modifiers associated with radiopharmaceuticals, and how per-unit billing is reflected in service lines.
This resource provides benchmarks for reporting and documentation expectations, summarizes common payer considerations, and places the code in clinical context for nuclear medicine teams and billing professionals. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code A9556 represents Gallium Ga-67 citrate, diagnostic, per millicurie. This billing code describes a radiopharmaceutical used for diagnostic nuclear medicine imaging studies, supplied and billed per millicurie of activity.
Service Type: Diagnostic radiopharmaceutical administration for nuclear medicine imaging
Typical Site of Service: Hospital outpatient imaging departments, hospital inpatient nuclear medicine departments, and freestanding imaging centers
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred from oncology or infectious disease for diagnostic nuclear medicine imaging to localize occult infection, inflammation, or metastatic disease using gallium Ga-67 citrate. The patient often presents with persistent fever of unknown origin, suspected pulmonary or abdominal abscess, or evaluation of lymphoma recurrence following equivocal CT or PET/CT. The ordering clinician documents the indication and relevant clinical history. On the day of service, a registered nurse or nuclear medicine technologist verifies identity, reviews allergies and pregnancy status, obtains informed consent per facility policy, and administers A9556 (gallium Ga-67 citrate) by intravenous injection. Imaging typically occurs at multiple time points (24–72 hours postinjection) in the nuclear medicine department or hospital radiology suite. Images are acquired by a nuclear medicine technologist and interpreted by a radiologist or nuclear medicine physician; the professional interpretation and any additional reports are appended to the patient record. Billing includes the drug unit A9556 per millicurie, administration services, and any imaging procedure codes as applicable. Typical site of service: outpatient hospital radiology/nuclear medicine department, freestanding imaging center, or inpatient hospital when ordered for hospitalized patients.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 |