Summary & Overview
HCPCS A9595: Piflufolastat F-18, Diagnostic Radiopharmaceutical, 1 mCi
HCPCS Level II code A9595 identifies piflufolastat F-18, a diagnostic radiopharmaceutical supplied in 1 millicurie units for PET imaging. This code matters nationally because it standardizes billing for an emerging PET tracer used in diagnostic imaging, affecting provider billing, payer coverage decisions, and access to specialty imaging services. Clear coding supports accurate claims submission and reimbursement for high-cost radiopharmaceuticals.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find national benchmarks for coverage and reimbursement practices, an overview of payer policy considerations, and clinical context about the service type and typical site of service. The publication outlines how the code is used in claims for outpatient imaging centers and hospital radiology departments and highlights common billing issues to monitor, such as unit reporting and documentation needs.
The analysis supplies actionable reference material: code definition and clinical use, payer coverage landscape, common administrative challenges, and pointers to relevant policy updates. Data limitations where input is incomplete are noted as "Data not available in the input." The content is intended for billing professionals, radiology administrators, and policy analysts seeking a concise national view of HCPCS Level II code A9595 and its role in PET imaging workflows.
Billing Code Overview
HCPCS Level II code A9595 represents piflufolastat F-18, a diagnostic radiopharmaceutical supplied in a unit of 1 millicurie. The code covers the provision of the radiotracer used for PET imaging to detect or stage disease processes where piflufolastat F-18 is indicated.
Service type: Diagnostic radiopharmaceutical administration for PET imaging.
Typical site of service: Outpatient imaging centers and hospital-based radiology departments where PET scans are performed.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old man with a history of prostate adenocarcinoma and rising prostate-specific antigen (PSA) after definitive therapy is referred for PET imaging with A9595 (piflufolastat F‑18, diagnostic, 1 millicurie) to localize recurrent or metastatic disease. The clinical workflow includes a referring urologist or medical oncologist ordering the PET scan; a nuclear medicine physician or radiologist and technologist coordinate radiopharmaceutical preparation and dose verification; the patient arrives fasting or per institutional protocol; intravenous access is obtained only if contrast or additional labs are needed; the radiopharmaceutical piflufolastat F-18 is administered intravenously; an uptake period of approximately 60 minutes is observed; whole‑body PET/CT acquisition is performed; images are reconstructed and interpreted by a board‑certified nuclear medicine physician; a report with lesion localization and standardized uptake values is sent to the referring clinician for management decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work, time, or complexity substantially exceeds usual for PET radiopharmaceutical administration or imaging-related tasks |