Summary & Overview
HCPCS A9586: Florbetapir F18 Diagnostic PET Dose, Up to 10 mCi
HCPCS Level II code A9586 covers administration of florbetapir F18 for diagnostic PET imaging, billed per study dose up to 10 millicuries. This radiopharmaceutical is used in amyloid PET scans to detect beta-amyloid plaque in the brain, a clinically relevant tool in evaluating patients with cognitive impairment and suspected Alzheimer disease pathology. Nationally, PET radiotracers like florbetapir influence utilization patterns, imaging center workflows, and payer coverage policies due to their specialized supply, handling, and interpretation requirements.
Key payers in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what A9586 represents, typical sites of service, and the clinical context for use. The publication also summarizes benchmark elements and policy considerations relevant to reimbursement and coverage determinations for radiopharmaceuticals, along with practical coding and billing context for service lines that manage PET imaging. Data not available in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code A9586 describes florbetapir F18 provided for diagnostic imaging, billed per study dose, up to 10 millicuries. This service represents administration of a radiopharmaceutical tracer used in PET imaging to evaluate beta-amyloid plaque in the brain for diagnostic purposes.
Service Type: Radiopharmaceutical diagnostic imaging study (PET tracer administration)
Typical Site of Service: Hospital outpatient department or ambulatory imaging center
Clinical & Coding Specifications
Clinical Context
A typical patient is an older adult referred by a neurologist for evaluation of progressive cognitive decline, memory loss, or suspected Alzheimer disease when amyloid imaging will affect clinical management. The patient arrives at an outpatient nuclear medicine or PET imaging center. After registration and review of indications, an IV line is placed and a measured study dose of Florbetapir F18 (up to 10 millicuries, billed as A9586) is administered. A 20–30 minute uptake period follows per local protocol, then the patient is positioned in the PET scanner for acquisition of images of the brain. Images are processed, interpreted by a board-certified nuclear medicine physician or neuroradiologist, and a report documenting presence or absence of cortical amyloid deposition is generated. Results are communicated to the referring clinician for integration into diagnosis and care planning. Typical site of service is an outpatient imaging center or hospital outpatient department. Typical modifiers applied depend on professional vs technical components, unusual procedural circumstances, or payer-specific reporting requirements (for example, professional component modifier 26, technical component modifier TC, or modifier for reduced services 52).
Coding Specifications
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