Summary & Overview
HCPCS Level II A9576: Injection, Gadoteridol (ProHance), per ml
HCPCS Level II code A9576 designates per-milliliter billing for gadoteridol (ProHance multipack), a gadolinium-based MRI contrast agent used to enhance diagnostic imaging. Nationally, accurate coding of contrast agents like A9576 matters for appropriate reimbursement, inventory tracking, and clinical documentation tied to contrast-enhanced MRI scans.
Key payers in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for gadoteridol use, typical sites of service (outpatient imaging centers and hospital radiology), and the billing presentation for a multipack, per-milliliter code. The publication covers benchmarking concepts, common billing practice considerations, and any notable policy or coverage issues that affect contrast agent coding and payment nationally. Where available, payer-specific coverage notes and coding guidance are summarized; where input data is not provided, the report indicates that information is not available in the input.
The content serves coding professionals, revenue cycle analysts, and clinical administrators seeking clear, national-level information about the code, its clinical application, and the payer landscape relevant to contrast-enhanced MRI services.
Billing Code Overview
HCPCS Level II code A9576 describes Injection, gadoteridol, (ProHance multipack), per ml. This code represents a radiographic contrast agent (gadoteridol) supplied in a multipack format and billed per milliliter. The service type is contrast-enhanced diagnostic imaging support for magnetic resonance imaging (MRI) procedures that require a gadolinium-based contrast agent. The typical site of service is outpatient imaging centers and hospital radiology departments where MRI studies are performed.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred for a contrast-enhanced magnetic resonance imaging (MRI) study of the brain, spine, or joints to evaluate for tumor, infection, inflammation, demyelinating disease, or internal derangement. The patient arrives at an outpatient radiology imaging center or hospital radiology department. The clinical workflow includes verification of the exam order and indications, review of renal function (e.g., recent serum creatinine or eGFR), allergy screening, informed consent for intravenous contrast, placement of an IV cannula by a registered nurse or radiology technologist, and preparation of the gadoteridol (ProHance) multipack vial(s). The radiologist or qualified MRI technologist administers the contrast intravenously, typically calculated by weight-based volume in milliliters; the billing code A9576 is reported per milliliter of gadoteridol used. Post-injection monitoring for immediate adverse reaction occurs for several minutes; the patient then undergoes the MRI sequences requiring contrast. Documentation includes indication, informed consent, renal function assessment, volume of A9576 injected (ml), lot number and expiration, site and method of administration, any immediate reactions and management, and the performing provider and their taxonomy. Typical sites of service are outpatient radiology centers, hospital outpatient departments, and inpatient hospital settings for emergent imaging.
Coding Specifications
| Modifier | Description | When to Use |
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