Summary & Overview

HCPCS A9569: Technetium Tc-99m Exametazime Labeled Autologous WBC, Diagnostic, Per Study Dose

HCPCS Level II code A9569 represents a diagnostic nuclear medicine procedure in which a patient’s autologous white blood cells are labeled with technetium Tc-99m exametazime and administered for imaging to localize infection or inflammation. This procedure is clinically important for detecting occult infections, prosthetic joint or vascular graft infections, and other inflammatory processes when conventional imaging is inconclusive. Nationally, accurate coding and coverage determination for radiolabeled leukocyte studies affect utilization of advanced diagnostic imaging and downstream care decisions.

Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes how these payers typically approach coverage and coding for radiolabeled autologous white blood cell studies, and highlights common billing considerations.

Readers will find a concise clinical context for the procedure, typical sites of service, common modifiers used in billing, and an overview of payer coverage patterns and potential policy considerations. The report also provides benchmarking context where available, notes relevant coding relationships, and identifies areas where readers may need to consult payer-specific medical policies or local coverage determinations. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA9569HCPCS Level IInuclear medicineradiolabeled leukocytesinfection imagingdiagnostic imagingtechnetium tc-99mautologous white blood cells

Billing Code Overview

HCPCS Level II code A9569 describes Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose. This service involves labeling a patient’s own white blood cells with technetium Tc-99m exametazime for diagnostic imaging to detect sites of infection or inflammation.

Service type: Diagnostic nuclear medicine procedure involving radiolabeled autologous leukocytes
Typical site of service: Hospital outpatient imaging centers, nuclear medicine departments, or ambulatory imaging facilities

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a history of recurrent fever of unknown origin and a recent prosthetic joint replacement presents with persistent low-grade fever and localized pain near the prosthetic hip. Laboratory testing shows elevated inflammatory markers (CRP, ESR) but blood cultures are negative. The treating team orders a technetium Tc-99m exametazime labeled autologous white blood cell scan to localize possible occult infection or to evaluate for prosthetic joint infection before considering revision surgery.

Workflow: The patient is referred by the orthopedist or infectious disease specialist to nuclear medicine. On the day of the study, staff perform autologous blood withdrawal, label the patient’s white blood cells with Tc-99m exametazime, and reinject the labeled cells. Serial planar and/or SPECT/CT imaging is obtained at appropriate intervals per institutional protocol to detect focal radiotracer accumulation. Images are interpreted by a board-certified nuclear medicine physician and final report is communicated to the referring clinician for management planning.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	Use when no specific modifier applies to the service.
`22`	Increased procedural services	Use when work required is substantially greater than typical for the procedure (document justification).
`52`	Reduced services	Use when the service is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is started but terminated due to patient condition or emergent circumstance.
`59`	Distinct procedural service	Use to indicate a separate, distinct service not normally reported together; e.g., if multiple distinct imaging procedures are performed on the same day.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons during a surgical procedure related to findings from the scan.
`78`	Return to OR for a related procedure during postoperative period	Use if a patient returns to the operating room for a related procedure after imaging-guided diagnosis.
`80`	Assistant surgeon	Use when an assistant surgeon is documented for an operative procedure related to the imaging findings.
`82`	Assistant surgeon (when a qualified resident is not available)	Use when an assistant surgeon is required and a qualified resident is unavailable.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare patients	Use when a qualifying non-physician practitioner furnishes professional services related to the visit.
`CO`	Skilled nursing facility (SNF) consolidated billing exclusion modifier	Use when the service is excluded from SNF consolidated billing and billed separately.
`TC`	Technical component	Use when billing only the technical component of the imaging study (radiopharmaceutical handling, imaging acquisition).
`QK`	Medical direction by a physician with two or more concurrent anesthesia procedures	Use if anesthesia medical direction is documented and applicable to the imaging procedure.
`QX`	CRNA service with qualified anesthetist absence of medical direction	Use when a CRNA provides anesthesia without physician direction for procedures requiring anesthesia.

Taxonomy Code	Specialty	Notes
`207K00000X`	Radiology — Diagnostic Radiology	Nuclear medicine imaging commonly performed in diagnostic radiology settings.
`207L00000X`	Nuclear Medicine	Specialists who perform and interpret nuclear medicine studies, including labeled WBC scans.
`2080P0004X`	Infectious Disease	Referring specialty that frequently orders localized infection imaging.
`207P00000X`	Orthopedic Surgery	Referring specialty for prosthetic joint infection evaluation and management.
`363A00000X`	Clinical Laboratory	Personnel involved in blood handling and radiolabeling of autologous WBCs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M00.9`	Pyogenic arthritis, unspecified	Localization of joint infection in native or prosthetic joints.
`T84.5X5A`	Infection and inflammatory reaction due to internal joint prosthesis, initial encounter	Direct indication for labeled WBC scanning to evaluate prosthetic joint infection.
`R50.9`	Fever, unspecified	Workup of fever of unknown origin when occult infection is suspected.
`A41.9`	Sepsis, unspecified organism	Used when systemic infection is present and a source needs localization.
`L03.90`	Cellulitis, unspecified	Localization of soft tissue infection when extent or deep involvement is uncertain.
`M86.9`	Osteomyelitis, unspecified	Evaluation for bone infection, where labeled WBC imaging can help localize active osteomyelitis.
`I33.9`	Endocarditis, unspecified	When persistent bacteremia or suspected infective endocarditis prompts imaging to find metastatic infectious foci.
`K65.9`	Peritonitis, unspecified	Used when intra-abdominal infection is suspected and WBC localization may assist in identifying abscesses.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78293`	White blood cell localization study, including acquisition, planar and/or SPECT; limited	Commonly used CPT code for WBC localization imaging when CPT coding applies alongside HCPCS billing for radiopharmaceuticals.
`78800`	Radiopharmaceutical localization of tumor or distribution, planar imaging, single area	Performed when planar imaging is used as part of localization; may be used for additional planar sequences.
`78803`	Radiopharmaceutical localization of tumor or distribution, SPECT	Used when SPECT acquisition is performed in conjunction with the labeled WBC study to improve localization accuracy.
`71046`	Radiologic examination, chest; single view, frontal	Performed pre-procedure or post-procedure to evaluate for alternate sources of infection such as pneumonia when clinically indicated.
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance) subcutaneous or intramuscular	Billed when additional injections (e.g., adjunctive tracers or contrast) are administered as part of the procedure workflow.