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    v1.0.28
    OpenPayerBilling CodesAdministrative, Miscellaneous and InvestigationalHCPCS hcpcs-a9591-fluoroestradiol-f18-diagnostic-pet-agent-1-millicurie
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    HCPCS Level II A9591: Fluoroestradiol F 18, Diagnostic, 1 Millicurie

    HCPCS Level II code A9591 describes administration of fluoroestradiol F 18 as a diagnostic radiopharmaceutical, typically billed per 1 millicurie dose; the service represents a diagnostic nuclear medicine radiotracer injection used to evaluate estrogen receptor–expressing tissues and is most often performed in an outpatient imaging center or hospital nuclear medicine department for PET imaging studies.

    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 a woman with a history of estrogen receptor–positive breast cancer being evaluated for recurrent or metastatic disease. The referring oncologist orders a PET imaging study using A9591 (fluoroestradiol F 18, diagnostic, 1 millicurie) to assess in vivo estrogen receptor expression in suspected metastatic lesions or to clarify equivocal findings on conventional imaging. The clinical workflow: the patient arrives at an outpatient nuclear medicine or PET/CT center, screening for pregnancy and recent hormonal therapies is performed, IV access is obtained, and the radiopharmaceutical A9591 is administered. After an uptake period per protocol, PET/CT imaging is performed. Images are reviewed by a nuclear medicine physician or radiologist; findings are reported to the referring oncologist to guide systemic therapy selection (for example, endocrine therapy eligibility) or further biopsy planning. Typical site of service is an outpatient imaging center or hospital-based nuclear medicine/PET suite. Usual patient preparation includes fasting per site protocol, withholding select endocrine agents as clinically indicated, and assessing renal function when relevant.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    78814Positron emission tomography (PET) small molecule, with concurrent computed tomography (PET/CT), whole body, single imaging agentCommonly used when PET/CT is performed at the same session as administration of A9591 to provide anatomic correlation and staging.
    78815Positron emission tomography (PET) small molecule, with concurrent computed tomography (PET/CT), whole body, multiple bed positions; with single imaging agent, diagnosticAlternate PET/CT whole-body code used depending on protocol/coverage rules.
    78816Positron emission tomography (PET) tumor imaging, limited area; with concurrent computed tomography (PET/CT)Used when imaging is limited to a specific body region rather than whole body.
    77336Radiation treatment device-specific simulation (e.g., CT simulation), image acquisitionMay be used in workflows when PET/CT data are incorporated into radiation therapy planning.
    96372Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscularUsed if a separate documented injection service is billed for administration, though PET radiopharmaceuticals are typically billed with radiopharmacy/technical components rather than this code.
    99214Office or other outpatient visit for the evaluation and management of an established patient, moderate complexityRepresents the oncology follow-up visit where PET results are reviewed and treatment decisions are made.

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    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…
    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…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RC0000XCardiovascular Disease PhysicianAn internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    363A00000XPhysician AssistantA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
    2084A2900XNeurocritical Care PhysicianThe medical subspecialty of Neurocritical Care is devoted to the comprehensive, multisystem care of the critically-ill neurological patient. Like othe…
    204C00000XSports Medicine (Neuromusculoskeletal Medicine) PhysicianA Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine physician trained to be responsible for the continuous care in the field of spor…
    103TM1800XIntellectual & Developmental Disabilities PsychologistBehavioral Health & Social Service Providers · Psychologist
    2279S1500XSNF/Subacute Care Registered Respiratory TherapistCare of residents in a long-term care environment. Respiratory modalities delivered include those similar in the general care and critical care areas…

    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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