Summary & Overview
HCPCS Level II A9566: Technetium tc-99m Fanolesomab, Diagnostic
HCPCS Level II code A9566 identifies technetium tc-99m fanolesomab, a diagnostic radiopharmaceutical supplied per study dose (up to 25 millicuries). This code governs billing for a nuclear medicine imaging agent used in diagnostic studies and is relevant to hospitals, outpatient imaging centers, and other facilities providing nuclear medicine services. Nationally, standardized identification of radiopharmaceuticals supports consistent reimbursement, inventory control, and quality measurement across payers.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines clinical context for the agent, the typical sites of service, and payer coverage considerations. Readers will find benchmarks for utilization and reimbursement where available, summaries of relevant policy considerations, and operational notes for billing and coding teams. When specific data elements were not provided in the input, the text clearly indicates that those data are not available.
This summary is intended for health system revenue cycle leaders, clinical operations staff, and policy analysts seeking a concise reference on the billing characteristics and payer landscape for A9566 technetium tc-99m fanolesomab diagnostic studies.
Billing Code Overview
HCPCS Level II code A9566 represents technetium tc-99m fanolesomab, a radiopharmaceutical used for diagnostic imaging, billed per study dose, up to 25 millicuries. The service type is nuclear medicine diagnostic radiopharmaceutical administration. The typical site of service for this code is hospital outpatient departments and imaging centers where nuclear medicine studies are performed. Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult inpatient or outpatient being evaluated for suspected focal infection or occult abscess where conventional imaging is inconclusive. The procedure involves intravenous administration of A9566 (technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries) followed by planar and/or SPECT imaging by a nuclear medicine technologist and interpretation by a nuclear medicine physician or radiologist. Common presenting scenarios include fever of unknown origin, suspected postoperative or catheter-related infection, or focal pain with elevated inflammatory markers (e.g., leukocytosis, elevated C-reactive protein) where localization of neutrophil-mediated inflammation is needed. The clinical workflow: patient screening for allergies and renal function, informed consent, radiopharmacy preparation and dose verification, IV administration of the radiotracer, uptake period as per institutional protocol, image acquisition, image processing, and physician interpretation with a report documenting localization of abnormal radiotracer uptake and correlation to clinical findings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard use when no special circumstances apply |