Summary & Overview
HCPCS A9568: Technetium Tc-99m Arcitumomab Diagnostic Study Dose
HCPCS Level II code A9568 represents technetium tc-99m arcitumomab, a radiopharmaceutical used for diagnostic imaging, billed per study dose up to 45 millicuries. Nationally, radiopharmaceutical codes matter for hospital outpatient, ambulatory imaging centers, and nuclear medicine providers because they affect coverage determinations, prior authorization workflows, and payment policy for specialized diagnostic agents. HCPCS Level II code A9568 is specific to a technetium-99m labeled imaging agent used in nuclear medicine studies.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns, typical sites of service billing implications, and coding context relevant to billing and claims processing for radiopharmaceuticals.
Readers will find concise benchmarks and explanatory context about the clinical use of the agent, typical billing scenarios by site of service, and national policy considerations that influence reimbursement and utilization management. The document also highlights where input data was unavailable and where readers should expect variability across payers and facilities.
Billing Code Overview
HCPCS Level II code A9568 describes technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries. This code represents a radiopharmaceutical diagnostic agent administered for imaging studies using technetium-99m labeled arcitumomab.
Service Type: Diagnostic radiopharmaceutical administration for nuclear medicine imaging
Typical Site of Service: Hospital outpatient imaging departments, nuclear medicine clinics, and ambulatory imaging centers
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with known or suspected colorectal carcinoma presenting for tumor localization and staging using a radiolabeled monoclonal antibody imaging agent. The nuclear medicine team receives an order for technetium tc-99m arcitumomab (A9568) to perform a diagnostic planar scintigraphy and single-photon emission computed tomography (SPECT) study. Prior to the study, the patient is screened for pregnancy, recent contrast studies, and allergies. The radiopharmacy prepares a unit dose up to 45 millicuries of Technetium tc-99m arcitumomab and delivers it under standard radiation safety procedures. The patient is injected intravenously, observed for immediate adverse reactions, and then imaged at protocol-specified time points. Images are acquired by a nuclear medicine technologist and interpreted by a nuclear medicine physician or radiologist. Typical sites of service include outpatient nuclear medicine departments, hospital-based imaging centers, and inpatient radiology suites for hospitalized oncology patients. Relevant clinical workflow steps include patient consent, dose preparation and documentation, administration with modifier coding as appropriate, image acquisition (planar and/or SPECT), post-procedure monitoring, and physician interpretation and reporting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |