Summary & Overview
HCPCS A9585: Gadobutrol Injection, 0.1 ml
HCPCS Level II code A9585 designates the administration of gadobutrol contrast, billed per 0.1 ml, primarily used to enhance magnetic resonance imaging (MRI) studies. This reagent-level code matters nationally because contrast agent billing affects imaging cost reporting, clinical documentation, and payer medical necessity reviews. Accurate coding influences facility and professional billing, inventory control, and patient cost-sharing calculations.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how A9585 is used in imaging workflows, typical sites of service where the injection is administered, and the role of per-volume contrast billing in claims and reimbursement processes. The publication reviews common modifier contexts and payer considerations where available, and it explains what benchmark and policy items are relevant to institutions that manage MRI contrast utilization.
The content is intended to help billing managers, radiology administrators, and policy analysts understand the code’s clinical context, documentation expectations, and where to look for payer-specific policy updates. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code A9585 represents an injection of gadobutrol, measured per 0.1 ml. This code covers administration of the gadobutrol contrast agent commonly used for magnetic resonance imaging (MRI) studies.
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Service type: Contrast agent injection for radiologic imaging
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Typical site of service: Imaging centers, hospital outpatient departments, and radiology suites where MRI procedures are performed
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Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult or pediatric patient undergoing contrast-enhanced magnetic resonance imaging (MRI) for diagnostic evaluation of neurologic, musculoskeletal, abdominal, or vascular pathology. The radiology team prepares and administers the gadolinium-based contrast agent gadobutrol as an intravenous injection measured in 0.1 ml units per billing code A9585. Common indications include evaluation of suspected intracranial neoplasm, multiple sclerosis plaques, spine or joint pathology, liver lesion characterization, and vascular malformations. The clinical workflow: the ordering provider documents indication and relevant history; nursing or radiology technologist screens for renal function and prior contrast reactions; informed consent is obtained when required; a radiologist or qualified advanced practitioner oversees contrast administration; the dose is drawn from the supplied vial or syringe and recorded; post-injection monitoring for immediate hypersensitivity reactions occurs in the imaging suite; the radiologist interprets MRI sequences acquired before and after contrast, and the report with findings is delivered to the ordering provider.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician/radiologist interpretation separate from technical imaging services. |