Summary & Overview
HCPCS A9588: Fluciclovine F-18, Diagnostic PET Imaging Agent, 1 mCi
HCPCS Level II code A9588 denotes fluciclovine f-18, a radiopharmaceutical agent supplied as 1 millicurie for diagnostic PET imaging. This tracer is principally used in oncology imaging protocols where PET scans aid in detection, localization, or restaging of malignancy. Nationally, accurate coding for radiopharmaceuticals like A9588 matters for appropriate claim processing, clinical documentation, and coordination between imaging providers and payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a consolidated overview of coverage and billing considerations for A9588, along with benchmarking context where available, common clinical settings in which the agent is used, and typical sites of service. The publication outlines policy-relevant issues affecting radiopharmaceutical reimbursement, claims submission elements tied to this HCPCS Level II code, and how A9588 fits into imaging service lines.
The report is intended for billing professionals, radiology administrators, and policy analysts seeking concise guidance on the clinical role and payer landscape for fluciclovine f-18 PET imaging supplies billed under A9588. Data not available in the input will be explicitly noted.
Billing Code Overview
HCPCS Level II code A9588 represents fluciclovine f-18, diagnostic, 1 millicurie. This code is used for billing a radiopharmaceutical agent comprising a positron emission tomography (PET) imaging tracer labeled with fluorine-18.
Service type: Diagnostic radiopharmaceutical administration for PET imaging.
Typical site of service: Outpatient imaging centers and hospital outpatient departments where PET scans are performed.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult male with a history of treated prostate cancer who presents with rising prostate-specific antigen (PSA) levels suggesting biochemical recurrence. The oncology and urology team orders a positron emission tomography (PET) study using Fluciclovine F-18 to localize recurrent or metastatic disease. The clinical workflow includes: referral by a urologist or medical oncologist; preauthorization and verification of benefit with payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare; scheduling at an outpatient imaging center or hospital radiology department; radiopharmacy preparation and dose calibration of A9588 (fluciclovine F-18, diagnostic, 1 millicurie); intravenous administration by a nuclear medicine technologist under protocol; PET/CT acquisition by nuclear medicine/diagnostic radiology; image interpretation and generation of a formal report by a board-certified nuclear medicine physician or diagnostic radiologist; and billing for the radiopharmaceutical using A9588 plus technical and professional components as applicable. Patient monitoring for adverse reactions occurs during and after injection; results guide restaging and treatment planning such as salvage radiotherapy or systemic therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
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