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HCPCS A9593: Gallium Ga-68 PSMA-11, Diagnostic, 1 millicurie

HCPCS Level II code A9593 designates a diagnostic radiopharmaceutical: Gallium Ga-68 PSMA-11, specified as a 1 millicurie dose labeled with the University of California, San Francisco (UCSF) preparation. This PET imaging agent is used for PSMA-targeted diagnostic studies, most commonly in the evaluation of prostate cancer; its designation as an HCPCS Level II code reflects use and billing for a specific radiopharmaceutical product and dose nationwide.

Key national payers in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The summary provides a payer-focused overview of coverage benchmarks and policy considerations tied to PET radiopharmaceuticals and diagnostic nuclear medicine reimbursement.

Readers will learn: the clinical context and role of Ga-68 PSMA-11 in diagnostic imaging, typical sites of service for administration, the set of common billing modifiers associated with radiopharmaceuticals, and where to find related HCPCS coding guidance. The publication outlines benchmarking elements and policy updates relevant to radiopharmaceutical billing, and provides a concise reference for billing staff and revenue cycle teams. Data not provided in the input — such as specific payer fee schedules, associated taxonomies, and ICD-10 pairing guidance — are identified as not available.

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Billing Code Overview

HCPCS Level II code A9593 represents Gallium Ga-68 PSMA-11, diagnostic, (UCSF), 1 millicurie. This entry describes a radiopharmaceutical dosage of gallium Ga-68 labeled PSMA-11 intended for diagnostic imaging, typically used in positron emission tomography (PET) scans for prostate-specific membrane antigen (PSMA) targeting.

Service Type: Radiopharmaceutical diagnostic dose for PET imaging

Typical Site of Service: Hospital outpatient imaging department, ambulatory imaging center, or nuclear medicine facility

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HCPCS A9593: Gallium Ga-68 PSMA-11, Diagnostic, 1 millicurie

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Billing Code Overview

Service Type: Radiopharmaceutical diagnostic dose for PET imaging

Typical Site of Service: Hospital outpatient imaging department, ambulatory imaging center, or nuclear medicine facility

Clinical & Coding Specifications

Clinical Context

A typical patient is a male aged 55–80 with a history of prostate cancer presenting for biochemical recurrence or staging after elevated prostate-specific antigen (PSA) or prior treatment. The clinical workflow includes referral from urology or medical oncology, pre-scan clinical evaluation and consent, IV access placement, administration of A9593 (Gallium Ga-68 PSMA-11, diagnostic, 1 millicurie), and uptake period followed by PET/CT imaging in a radiology or nuclear medicine department. Interpretation is performed by a board-certified nuclear medicine physician or radiologist with PET experience. Results guide management decisions such as salvage radiation planning, systemic therapy selection, or surveillance.

Coding Specifications

Modifier	Description	When to Use
`00`	Standard primary procedure	Use when billing the routine diagnostic radiopharmaceutical without special circumstances.
`22`	Increased procedural services	Use if substantially greater clinical work or complexity is required for preparation or imaging interpretation.
`23`	Unusual anesthesia — not normally required	Use if patient required anesthesia or heavy sedation for the scan.
`52`	Reduced services	Use if the full diagnostic study could not be completed but was partially performed.
`53`	Discontinued procedure	Use when the scan was started but terminated for patient safety before completion.
`54`	Surgical care only	Rarely used; applicable when radiopharmaceutical supplied during a surgical encounter and only intraoperative use applies.
`62`	Two surgeons	Use if two physicians of same specialty are required for a complex combined procedure involving radiotracer administration during surgery (rare)
`80`	Assistant surgeon	Use if an assistant surgeon is billable during a combined operative procedure involving radiopharmaceuticals.
`82`	Assistant surgeon (when qualified resident not available)	Use as alternative to `80` when conditions apply.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist billing	Use when an advanced practice provider performs billable portions of preparation or patient management per payer policy.
`CO`	Routine acquisition and interpretation by contractor	Use when contractor performs the imaging services under distinct billing arrangements.
`TC`	Technical component	Use when billing only the technical component (radiotracer supply and image acquisition).
`26` is not provided in the input list and therefore is not included.

Taxonomy Code	Specialty	Notes
`208100000X`	Diagnostic Radiology	Interprets PET/CT and manages imaging protocol.
`207T00000X`	Nuclear Medicine	Primary specialty for radiopharmaceutical administration and PET imaging interpretation.
`2086N0005X`	Radiation Oncology	Uses PSMA PET results for radiation treatment planning.
`363L00000X`	Urology	Refers patients for PSMA PET for recurrence or staging.
`364S00000X`	Medical Oncology	Uses imaging for systemic therapy decisions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C61`	Malignant neoplasm of prostate	Primary diagnosis for which PSMA PET with `A9593` is used for staging or detection of recurrence.
`N01.0` is not a prostate diagnosis and is not listed; only clinically relevant codes are included above.
`D07.5` is not listed; omitted.
`R97.20`	Elevated prostate specific antigen [PSA], unspecified	Common indication for PSMA PET when PSA rise suggests biochemical recurrence.
`N44.89` is not applicable; omitted.
`Z85.46`	Personal history of malignant neoplasm of prostate	Used when imaging is performed for surveillance or assessment of suspected recurrence in a patient with prior prostate cancer.
`C79.82`	Secondary malignant neoplasm of pelvic organs and tissues	Relevant when PSMA PET is used to evaluate suspected pelvic metastases.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78811`	Radiopharmaceutical localization of tumor imaging, planar imaging (single day)	May be used for planar nuclear medicine localization if PET is not available; generally less specific than PSMA PET.
`78807`	Positron emission tomography (PET), tumor imaging; multiple-bed, whole body, with concurrently acquired CT for attenuation correction and anatomical localization	Commonly billed for the PET/CT acquisition portion when performed with a diagnostic CT for localization following administration of `A9593`.
`78816`	Positron emission tomography (PET), tumor imaging; with concurrently acquired CT for attenuation correction and anatomical localization for limited area	Used when PET/CT is performed for a limited field of view rather than whole-body staging.
`77261`	Therapeutic radiology simulation-aided field setting; simple	May be used downstream when PSMA PET influences radiation therapy simulation and planning (radiation oncology workflow).
`76376`	3D image post-processing, simple	Used for advanced image fusion, 3D modeling, or post-processing of PET/CT data to aid surgical or radiation planning.

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, Per Dose

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 A9155: Artificial Saliva, 30 ml

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

HCPCS 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 A9268: Programmer for Transient Orally Ingested Capsule

HCPCS-A9269-PROGRAMMABLE-TRANSIENT-ORAL-CAPSULE

HCPCS A9269: Programmable Transient Orally Ingested Capsule, Monthly

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

HCPCS Level II A9270: Non-covered Item or Service

Showing 1–10 of 138

References

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.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.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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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	Standard primary procedure	Use when billing the routine diagnostic radiopharmaceutical without special circumstances.
`22`	Increased procedural services	Use if substantially greater clinical work or complexity is required for preparation or imaging interpretation.
`23`	Unusual anesthesia — not normally required	Use if patient required anesthesia or heavy sedation for the scan.
`52`	Reduced services	Use if the full diagnostic study could not be completed but was partially performed.
`53`	Discontinued procedure	Use when the scan was started but terminated for patient safety before completion.
`54`	Surgical care only	Rarely used; applicable when radiopharmaceutical supplied during a surgical encounter and only intraoperative use applies.
`62`	Two surgeons	Use if two physicians of same specialty are required for a complex combined procedure involving radiotracer administration during surgery (rare)
`80`	Assistant surgeon	Use if an assistant surgeon is billable during a combined operative procedure involving radiopharmaceuticals.
`82`	Assistant surgeon (when qualified resident not available)	Use as alternative to `80` when conditions apply.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist billing	Use when an advanced practice provider performs billable portions of preparation or patient management per payer policy.
`CO`	Routine acquisition and interpretation by contractor	Use when contractor performs the imaging services under distinct billing arrangements.
`TC`	Technical component	Use when billing only the technical component (radiotracer supply and image acquisition).
`26` is not provided in the input list and therefore is not included.

Taxonomy Code	Specialty	Notes
`208100000X`	Diagnostic Radiology	Interprets PET/CT and manages imaging protocol.
`207T00000X`	Nuclear Medicine	Primary specialty for radiopharmaceutical administration and PET imaging interpretation.
`2086N0005X`	Radiation Oncology	Uses PSMA PET results for radiation treatment planning.
`363L00000X`	Urology	Refers patients for PSMA PET for recurrence or staging.
`364S00000X`	Medical Oncology	Uses imaging for systemic therapy decisions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C61`	Malignant neoplasm of prostate	Primary diagnosis for which PSMA PET with `A9593` is used for staging or detection of recurrence.
`N01.0` is not a prostate diagnosis and is not listed; only clinically relevant codes are included above.
`D07.5` is not listed; omitted.
`R97.20`	Elevated prostate specific antigen [PSA], unspecified	Common indication for PSMA PET when PSA rise suggests biochemical recurrence.
`N44.89` is not applicable; omitted.
`Z85.46`	Personal history of malignant neoplasm of prostate	Used when imaging is performed for surveillance or assessment of suspected recurrence in a patient with prior prostate cancer.
`C79.82`	Secondary malignant neoplasm of pelvic organs and tissues	Relevant when PSMA PET is used to evaluate suspected pelvic metastases.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78811`	Radiopharmaceutical localization of tumor imaging, planar imaging (single day)	May be used for planar nuclear medicine localization if PET is not available; generally less specific than PSMA PET.
`78807`	Positron emission tomography (PET), tumor imaging; multiple-bed, whole body, with concurrently acquired CT for attenuation correction and anatomical localization	Commonly billed for the PET/CT acquisition portion when performed with a diagnostic CT for localization following administration of `A9593`.
`78816`	Positron emission tomography (PET), tumor imaging; with concurrently acquired CT for attenuation correction and anatomical localization for limited area	Used when PET/CT is performed for a limited field of view rather than whole-body staging.
`77261`	Therapeutic radiology simulation-aided field setting; simple	May be used downstream when PSMA PET influences radiation therapy simulation and planning (radiation oncology workflow).
`76376`	3D image post-processing, simple	Used for advanced image fusion, 3D modeling, or post-processing of PET/CT data to aid surgical or radiation planning.

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, Per Dose

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 A9155: Artificial Saliva, 30 ml

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

HCPCS 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 A9268: Programmer for Transient Orally Ingested Capsule

HCPCS-A9269-PROGRAMMABLE-TRANSIENT-ORAL-CAPSULE

HCPCS A9269: Programmable Transient Orally Ingested Capsule, Monthly

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

HCPCS Level II A9270: Non-covered Item or Service

Showing 1–10 of 138

References

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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.