Summary & Overview
HCPCS A9572: Indium In-111 Pentetreotide, Diagnostic, Per Study Dose
HCPCS Level II code A9572 represents Indium In-111 pentetreotide supplied for diagnostic imaging, billed per study dose up to 6 millicuries. This radiopharmaceutical is used for somatostatin receptor scintigraphy to localize neuroendocrine tumors and related indications. Nationally, the code matters because it is central to billing for a specialized diagnostic nuclear medicine study that carries distinct handling, preparation, and administration requirements and often involves high-cost single-dose radiopharmaceuticals.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context for the agent, typical sites of service, and the elements that affect billing and coverage decisions. The publication outlines expected service line placement, common modifiers and coding considerations (listed elsewhere), and what to expect when aligning clinical documentation with claims submission. It also highlights areas where policy variation among major payers can influence prior authorization, reimbursement, and site-of-service requirements.
This summary provides clinicians, coders, and revenue cycle staff with a practical reference to the code’s clinical purpose, payer landscape, and the administrative considerations relevant to national billing practice. Data not available in the input is noted where applicable within detailed sections.
Billing Code Overview
HCPCS Level II code A9572 describes Indium In-111 pentetreotide, supplied for diagnostic nuclear medicine imaging, billed per study dose, up to 6 millicuries. The service type is diagnostic radiopharmaceutical administration for somatostatin receptor imaging. The typical site of service is hospital outpatient imaging departments, nuclear medicine clinics, and freestanding imaging centers where radiopharmaceuticals are prepared and administered for single-study diagnostic scintigraphy.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred by oncology or endocrinology for localization or staging of somatostatin receptor–expressing neuroendocrine tumors (NETs) after biochemical or imaging suspicion. The patient presents to a nuclear medicine outpatient clinic or hospital radiology/nuclear medicine department. Prior to the procedure, the nuclear medicine physician reviews indications, recent labs (renal function), and current medications (e.g., octreotide therapy), and obtains informed consent. The radiopharmacy prepares A9572 (Indium-111 pentetreotide) up to the specified study dose. The patient receives the radiopharmaceutical by intravenous injection; imaging is typically performed with planar and single-photon emission computed tomography (SPECT) or SPECT/CT at specified time points (commonly 4 and 24 hours post-injection). The procedure includes monitoring for immediate reactions, documentation of dose administered and lot numbers, and recording of imaging acquisition times. The interpreting nuclear medicine physician provides a diagnostic report describing sites of radiotracer uptake, comparison to prior studies, and relevance to staging or localization. Billing captures the dose-based HCPCS Level II supply code A9572, associated imaging procedure codes, and applicable modifiers to reflect circumstances such as partial administration, technician service, or distinct procedural conditions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|