Summary & Overview

HCPCS Level II A9582: Iodine I-123 Iobenguane Diagnostic Study Dose

HCPCS Level II code A9582 identifies a diagnostic radiopharmaceutical: Iodine I-123 iobenguane, billed per study dose up to 15 millicuries. This code is used when administering a single study dose for nuclear medicine imaging to localize neuroendocrine tumors and related conditions. Nationally, accurate coding of radiopharmaceuticals affects payment, utilization tracking, and clinical workflows for advanced diagnostic imaging.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code denotes, typical settings of care, and the types of benchmarks and policy elements commonly examined in payer analyses for radiopharmaceuticals. The publication outlines expected benchmarking categories such as allowed amounts and utilization patterns, highlights common billing considerations for radiopharmaceutical doses, and summarizes relevant policy update themes affecting coverage and prior authorization practices.

This executive summary is intended for health plan analysts, revenue cycle managers, and clinical administrators seeking a national perspective on coding and billing for I-123 iobenguane diagnostic studies. Data not available in the input will be noted in the detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA9582HCPCS Level IIradiopharmaceuticalnuclear medicineiodine i-123diagnostic imagingiobenguaneimaging dose

Billing Code Overview

HCPCS Level II code A9582 describes Iodine I-123 iobenguane for diagnostic use, per study dose, up to 15 millicuries. This code represents the radiopharmaceutical dose administered for diagnostic scintigraphy using I-123 labeled iobenguane, a compound used to image neuroendocrine tissues such as pheochromocytomas and neuroblastomas.

Service type: Diagnostic nuclear medicine radiopharmaceutical administration

Typical site of service: Hospital outpatient departments or freestanding diagnostic imaging centers

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult or pediatric patient referred for localization of neuroendocrine or adrenal medullary tumors (such as pheochromocytoma or neuroblastoma) or for assessment of metastatic or recurrent disease when conventional imaging is inconclusive. The ordering clinician (endocrinologist, oncologist, or nuclear medicine physician) evaluates history, biochemical testing (elevated catecholamines or metanephrines), and prior imaging before scheduling an Iodine I-123 iobenguane (MIBG) diagnostic study. The patient arrives at an outpatient nuclear medicine or hospital radiology department; pregnancy status and recent iodine-containing contrast use are reviewed. The study involves intravenous administration of A9582 (Iodine I-123 iobenguane), usually up to 15 millicuries per study dose, followed by serial planar and SPECT or SPECT/CT imaging at institution-specific time points (commonly 24 hours and sometimes 48 hours post-injection). Nursing documents dose, lot number, and patient education. The nuclear medicine physician interprets images, correlates with laboratory and prior imaging, and issues a report used by the referring provider to guide staging, surgical planning, or selection for targeted radionuclide therapy.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional Component	Use when billing only the physician interpretation portion of the study separate from technical imaging services.
`TC`	Technical Component	Use when billing only the facility/technical component (radiopharmaceutical administration and imaging) separate from physician interpretation.
`52`	Reduced Services	Use when the study is partially diminished (eg, incomplete imaging due to patient intolerance) and full service was not provided.
`53`	Discontinued Procedure	Use when the procedure is started but discontinued for patient safety reasons prior to completion.
`76`	Repeat Procedure by Same Physician (Not in provided list)	Data not available in the input.
`78`	Unplanned Return to the Operating/Procedure Room by Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period	Use rarely if an interventional nuclear procedure required immediate return — generally not applicable but included in original modifier set.
`62`	Two Surgeons	Use if two qualifying practitioners share in a complex procedural episode involving operative tumor localization coordinated with imaging — limited applicability.
`80`	Assistant Surgeon	Use if an assistant surgeon participates in a related operative procedure billed separately from imaging services.
`22`	Unusual Procedural Services	Use when the study required significantly greater physician work than usual (extensive image correlation or multi-day imaging protocol).
`23`	Unusual Anesthesia	Use when general anesthesia was medically necessary for image acquisition (typically in uncooperative pediatric patients).
`52`	Reduced Services	Data already listed above.
`53`	Discontinued Procedure	Data already listed above.
`62`	Two Surgeons	Data already listed above.

Taxonomy Code	Specialty	Notes
`2080S0003X`	Nuclear Medicine Physician	Interprets and directs radiopharmaceutical imaging and reporting.
`207RH0000X`	Radiologist, Diagnostic Radiology	Interprets SPECT/CT images when nuclear medicine service is co-managed or when cross-sectional correlation is required.
`2084N0400X`	Pediatric Radiologist	Performs and interprets MIBG studies in pediatric patients with neuroblastoma.
`207SG0300X`	Endocrinologist	Orders the study for biochemical and clinical correlation in adrenal or neuroendocrine tumors.
`2085R0205X`	Oncologist	Uses imaging results for staging and therapeutic planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78800`	Radiopharmaceutical therapy or imaging agent, diagnostic, per study dose; planar imaging, single day	May describe planar imaging acquisition components performed after `A9582` administration when billed separately.
`78803`	Radiopharmaceutical localization of tumor; planar imaging, multiple areas	Used for multi-region planar imaging protocols associated with MIBG studies.
`78830`	Directed radiopharmaceutical localization of tumor, SPECT only; single day	Relates to SPECT imaging performed after `A9582` injection to localize lesions.
`78831`	Directed radiopharmaceutical localization of tumor, SPECT/CT	Used when combined SPECT/CT is performed for anatomic correlation following `A9582` administration.
`77012`	CT guidance for localization	May be performed when CT localization is required in hybrid SPECT/CT or pre-surgical planning; used adjunctively to the radiopharmaceutical study.