Summary & Overview
HCPCS A9580: Sodium Fluoride F-18 Diagnostic Dose for PET Bone Imaging
HCPCS Level II code A9580 covers sodium fluoride F-18 supplied for diagnostic imaging, billed per study dose up to 30 millicuries. This radiopharmaceutical is an established agent for PET bone imaging to assess skeletal metabolism and detect metastatic or metabolic bone disease. Nationally, accurate coding for radiopharmaceuticals affects hospital and imaging center payment flows and supports appropriate utilization tracking for high-cost diagnostic agents.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, expected sites of service, and the role of this agent in PET bone studies. The publication summarizes typical billing context and common modifiers provided in the input, highlights payer coverage considerations, and outlines what benchmarks and policy updates would be relevant for administrators and coding professionals.
This summary provides the clinical framing and billing identity of A9580, guidance on where the service is typically performed, and a roadmap of topics addressed in the full publication: coverage patterns, reimbursement benchmarks, coding practice notes, and intersections with radiology and nuclear medicine protocols. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
HCPCS Level II code A9580 represents sodium fluoride F-18 for diagnostic use, billed per study dose up to 30 millicuries. This radiopharmaceutical is used in nuclear medicine imaging to evaluate bone metabolism and detect osseous lesions.
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Service type: Diagnostic radiopharmaceutical administration for PET bone imaging
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Typical site of service: Hospital outpatient imaging centers, standalone nuclear medicine or PET/CT facilities, and tertiary care centers
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred by an oncologist or primary care physician for a diagnostic PET imaging study using A9580 (sodium fluoride F-18) to evaluate suspected or known osseous metastatic disease. The patient has a history of malignancy (for example, prostate, breast, or lung cancer) with new bone pain or rising tumor markers (e.g., PSA) prompting advanced skeletal imaging. Prior to arrival, the nuclear medicine clinic verifies patient identity, reviews contraindications (pregnancy, breastfeeding), confirms intravenous access availability, and reviews recent imaging and laboratory data. On the day of service, the technologist explains the procedure, obtains informed consent per facility policy, administers the radiopharmaceutical sodium fluoride F-18 intravenously up to 30 millicuries as ordered, and monitors the patient during uptake. Imaging acquisition is performed on a PET or PET/CT scanner after the appropriate uptake period. The interpreting nuclear medicine physician reviews PET/CT fusion images, documents findings, and issues a diagnostic report to the referring clinician. Billing for the radiopharmaceutical is reported with A9580 per study dose, and facility or professional services are billed separately using applicable CPT imaging and interpretation codes.
Coding Specifications
| Modifier | Description | When to Use |
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