Summary & Overview
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.
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
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. |