Summary & Overview
HCPCS A9567: Technetium Tc-99m Pentetate Aerosol for Ventilation Imaging
HCPCS Level II code A9567 covers technetium tc-99m pentetate supplied as a diagnostic aerosol, up to 75 millicuries per study dose, used primarily for pulmonary ventilation imaging. Nationally, radiopharmaceutical billing codes like A9567 are important for reimbursement of nuclear medicine studies that inform diagnosis and management of respiratory conditions such as suspected pulmonary embolism or obstructive lung disease. Reimbursement clarity for radiopharmaceuticals affects imaging access, facility workflows, and cost reporting across outpatient imaging centers and hospital nuclear medicine departments.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what A9567 represents clinically, typical sites of service, and the role of this agent in ventilation imaging. The publication also outlines what to expect in payer coverage patterns and benchmarks, highlights relevant policy updates affecting radiopharmaceutical reimbursement, and situates the code within clinical context for diagnostic lung imaging. Data not available in the input will be explicitly noted where applicable.
Billing Code Overview
HCPCS Level II code A9567 describes technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries. This billing code represents a radiopharmaceutical agent used for diagnostic aerosol inhalation studies, typically administered to evaluate pulmonary ventilation or distribution of inhaled tracer in the lungs. The service type is diagnostic radiopharmaceutical administration for pulmonary ventilation imaging. The typical site of service is outpatient imaging centers, nuclear medicine departments, or hospital outpatient settings.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric patient referred for a ventilation scintigraphy study to evaluate regional pulmonary ventilation using radiolabeled aerosol. Indications include suspected pulmonary embolism in conjunction with perfusion imaging, evaluation of chronic thromboembolic pulmonary hypertension, assessment of preoperative pulmonary function prior to lung resection, or unexplained dyspnea when ventilation–perfusion mismatch is suspected. The patient arrives to the nuclear medicine department or radiology suite; a technologist reviews allergies, pregnancy status, and recent inhalation therapy. The aerosol Technetium Tc-99m pentetate is prepared and calibrated to a study dose (up to 75 millicuries). The patient is instructed on breathing technique and positioned under the gamma camera. Dynamic or static ventilation images are acquired while the patient inhales the aerosol per protocol, followed by complementary perfusion imaging (radiolabeled macroaggregated albumin) when ordered. Images are reviewed by the interpreting nuclear medicine physician, who documents indications, dose administered, image findings, and comparison to prior studies. Billing uses HCPCS Level II code A9567 for the aerosol study dose; administration, imaging, and interpretation are reported using appropriate facility and physician codes and modifiers as indicated by circumstances of the service.
Coding Specifications
Modifier table
| Modifier | Description | When to Use |
|---|---|---|