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    v1.0.28
    OpenPayerBilling CodesAdministrative, Miscellaneous and InvestigationalHCPCS hcpcs-a9589-hexaminolevulinate-instillation-100mg
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    HCPCS A9589: Instillation of Hexaminolevulinate Hydrochloride, 100 mg

    HCPCS Level II code A9589 describes the instillation of hexaminolevulinate hydrochloride, 100 mg, a drug preparation used to facilitate fluorescence-guided visualization during cystoscopic procedures; the service is a drug instillation typically provided in an operative or procedure suite during cystoscopy or bladder cancer detection/diagnostic procedures.

    For related coverage guidance, see recent payer policy updates: Interferential Stimulation Devices (for home use), Prior Authorization for Durable Medical Equipment (DME), Breast Pumps.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult undergoing cystoscopic evaluation for suspected non-muscle invasive bladder cancer or surveillance after prior bladder cancer. The patient presents to an outpatient urology clinic or ambulatory surgical center for office cystoscopy or rigid/flexible cystoscopy in the procedure suite. After initial visual inspection of the bladder mucosa, the clinician instills hexaminolevulinate hydrochloride (100 mg, billed as A9589) into the bladder via a catheter and maintains dwell time (typically about 1 hour) to allow selective uptake by dysplastic or neoplastic urothelial cells. Following the incubation period, the bladder is drained and examined with a blue-light (photodynamic) cystoscopy system to identify areas of fluorescence that guide targeted biopsies or transurethral resection of bladder tumor (TURBT). Typical workflow steps: pre-procedure consent and topical/local or monitored anesthesia as indicated, catheter instillation of hexaminolevulinate, timed dwell period during observation, blue-light cystoscopic inspection, documentation of findings, targeted biopsy or resection as clinically indicated, and post-procedure monitoring and discharge instructions. Typical site of service is an outpatient urology clinic, ambulatory surgical center, or hospital outpatient department. Typical patient scenarios include initial evaluation of hematuria, diagnosis of suspected bladder tumor, or surveillance after prior bladder cancer diagnosis.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    52000Cystourethroscopy, diagnostic, with or without collection of urine sample(s) by catheterizationOften performed immediately before instillation to inspect the bladder and obtain baseline findings.
    52204Cystourethroscopy, with biopsy, single or multiplePerformed to obtain targeted biopsies of suspicious lesions identified under blue-light cystoscopy after instillation.
    52235Cystourethroscopy, with fulguration or excision of tumor(s) of bladder, single or multiple; transurethral resectionTURBT is commonly performed after fluorescence-guided identification of tumors following A9589 instillation.
    51702Injection of substance for diagnostic or therapeutic purposes into bladder via catheter (eg, instillation of agents)Represents instillation procedures; used when separate reporting for bladder instillation is appropriate per payer rules.
    99070Supplies and materials (eg, drugs, appliances) provided by the physician over and above those usually included with the office visit or procedureMay be used to report additional disposable supplies related to instillation when payer allows; note that A9589 itself is billed as HCPCS supply.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    225200000XPhysical Therapy Assistant(1)Physical therapist assistants are skilled health care providers who are graduates of a physical therapist assistant associate degree program accred…
    163WN0800XNeuroscience Registered NurseNursing Service Providers · Registered Nurse
    261QM2500XMedical Specialty Clinic/CenterAn entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical s…
    2086S0102XSurgical Critical Care PhysicianA surgeon with expertise in the management of the critically ill and postoperative patient, particularly the trauma victim, who specializes in critica…
    275N00000XMedicare Defined Swing Bed Hospital UnitA unit of a hospital that has a Medicare provider agreement and has been granted approval from HCFA to provide post-hospital extended care services an…
    225800000XRecreation TherapistA recreation therapist uses recreational activities for intervention in some physical, social or emotional behavior to bring about a desired change in…

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    C67.0Malignant neoplasm of trigone of bladder
    C67.1Malignant neoplasm of dome of bladder
    C67.2Malignant neoplasm of lateral wall of bladder
    C67.3Malignant neoplasm of anterior wall of bladder
    C67.4Malignant neoplasm of posterior wall of bladder
    C67.5Malignant neoplasm of bladder neck
    C67.6Malignant neoplasm of ureteric orifice
    C67.7Malignant neoplasm of urachus
    C67.8Malignant neoplasm of overlapping sites of bladder
    C67.9Malignant neoplasm of bladder, unspecified

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: Durable Medical Equipment (DME)1 / 3

    10 rows

    PolicyPayerEffective Date
    Interferential Stimulation Devices (for home use)Moda Health2026-10-01
    Prior Authorization for Durable Medical Equipment (DME)Blue Cross Blue Shield - Rhode Island2026-10-01
    Breast PumpsModa Health2026-09-01
    Personal Emergency Response SystemsCareSource Georgia2026-09-01
    Continuous Passive Motion (CPM) DevicesCigna2026-08-15
    Push-Rim Activated Power-Assist Device (E0986) — Manual Wheelchair Accessorymoda_health_plan_inc2026-08-13
    Beds and Mattresses (for Ohio Only)Colorado Rocky Mountain Health Plans2026-08-01
    Beds and Mattresses (for Kentucky Only)UnitedHealthcare2026-08-01
    Pneumatic Compression Devices (for Nebraska Only)UnitedHealthcare2026-08-01
    Indications for Coverage — Hospital beds, support surfaces, and safety enclosure beds (DME)Colorado Rocky Mountain Health Plans2026-08-01

    Related Codes

    HCPCS-A9150-NON-PRESCRIPTION-DRUGS

    HCPCS Level II A9150: Non-prescription Drugs

    HCPCS-A9152-SINGLE-ORAL-VITAMIN-MINERAL-DOSE

    HCPCS A9152: Single Oral Vitamin/Mineral/Trace Element

    HCPCS-A9153-MULTIVITAMIN-ORAL-PER-DOSE

    HCPCS A9153: Multiple Vitamins, Oral, Per Dose

    HCPCS-A9154-ARTIFICIAL-SALIVA-1ML

    HCPCS Level II A9154: Artificial saliva, 1 ml

    HCPCS-A9155-ARTIFICIAL-SALIVA-30ML

    HCPCS Level II A9155: Artificial Saliva, 30 mL

    HCPCS-A9156-ORAL-MUCOADHESIVE-PER-1ML

    HCPCS Level II A9156: Oral Mucoadhesive, Per 1 ml

    HCPCS-A9180-PEDICULOSIS-TOPICAL-TREATMENT-PATIENT-ADMINISTRATION

    HCPCS Level II A9180: Pediculosis Topical Treatment for Patient/Caretaker

    HCPCS-A9268-PROGRAMMER-TRANSIENT-INGESTED-CAPSULE

    HCPCS Level II A9268: Programmer for Transient Orally Ingested Capsule

    HCPCS-A9269-PROGRAMMABLE-TRANSIENT-ORAL-CAPSULE

    HCPCS Level II A9269: Programmable Orally Ingested Capsule, Per Month

    HCPCS-A9270-NON-COVERED-ITEM-OR-SERVICE

    HCPCS A9270: Non-covered Item or Service

    Showing 1–10 of 138

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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