Summary & Overview
HCPCS A9587: Gallium Ga-68 DOTATATE, Diagnostic, 0.1 mCi
HCPCS Level II code A9587 identifies Gallium Ga-68 DOTATATE in a 0.1 millicurie unit for diagnostic molecular imaging. This radiopharmaceutical is used in PET imaging to detect somatostatin receptor–positive neuroendocrine tumors and other indications where somatostatin receptor targeting is clinically relevant. Nationally, accurate coding for radiopharmaceuticals is important for appropriate reimbursement, supply-chain tracking, and ensuring consistent access to specialized diagnostic tools.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, an outline of common billing modifiers and their relevance, and notes on where data were available or not. The publication covers billing and coding benchmarks, payer coverage tendencies, and practical considerations for documenting radiopharmaceutical diagnostic services. It also highlights where input data were not provided and directs readers to seek payer-specific policy language for coverage criteria and prior authorization requirements.
This summary is written for a national audience and focuses on the purpose of the code, payer landscape, and the operational implications of using HCPCS Level II code A9587 for diagnostic Gallium Ga-68 DOTATATE.
Billing Code Overview
HCPCS Level II code A9587 represents Gallium Ga-68 DOTATATE supplied for diagnostic use in a unit strength of 0.1 millicurie. This entry describes the radiopharmaceutical agent used for molecular imaging of somatostatin receptor–expressing neuroendocrine tumors.
Service Type: Diagnostic radiopharmaceutical
Typical Site of Service: Hospital outpatient imaging center, freestanding imaging center, or nuclear medicine department
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a history of neuroendocrine tumor (NET) of the pancreas presents for staging and assessment of somatostatin receptor expression prior to consideration of peptide receptor radionuclide therapy (PRRT). The ordering nuclear medicine physician schedules a PET/CT using Gallium Ga-68 DOTATATE to localize primary tumor and metastatic disease. The clinical workflow includes preauthorization, radiopharmacy preparation of Gallium Ga-68 DOTATATE activity measured in 0.1 millicurie units per billing descriptor, patient screening for pregnancy and recent somatostatin analogue therapy, IV access placement, tracer injection, uptake period (typically ~45–90 minutes), PET/CT acquisition, image reconstruction, interpretation by an authorized nuclear medicine or radiology physician, and final report documenting somatostatin receptor–avid lesions and standardized uptake values (SUVs). Typical site of service is an outpatient imaging center or hospital outpatient department.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; default billing | Use when no modifier applies and service is provided as billed |