Find policies, billing codes, payers, states, and providers

HCPCS A9596: Gallium Ga-68 Gozetotide (Illuccix), Diagnostic, 1 mCi

HCPCS Level II code A9596 denotes Gallium Ga-68 gozetotide (Illuccix), a diagnostic radiopharmaceutical measured per 1 millicurie. This agent is used in nuclear medicine for PET imaging of somatostatin receptor–positive lesions and is increasingly relevant as advanced molecular imaging expands diagnostic precision in oncology and neuroendocrine tumor management. Nationally, accurate coding and billing for radiopharmaceuticals like A9596 affect access to PET imaging, provider reimbursement, and utilization monitoring.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses how these payers handle coverage and billing for radiopharmaceuticals, focusing on common payment considerations and the implications for imaging providers.

Readers will find benchmarks for coding and payment practice, a summary of relevant policy and coverage themes, and clinical context for when A9596 is used. The publication highlights practical billing considerations for institutional and outpatient settings and summarizes policy developments that influence access to Gallium Ga-68 gozetotide PET imaging. Data not available in the input will be identified where applicable.

Customize your policy alerts

Sign up for hcpcs A9596 policy alerts

Get alerted when payer policies referencing A9596 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

HCPCS Level II code A9596 represents Gallium Ga-68 gozetotide, diagnostic, (Illuccix), 1 millicurie, a radiopharmaceutical used for diagnostic imaging. This product is administered as a radioactive tracer for molecular imaging studies that target somatostatin receptor–expressing lesions.

Service type: Diagnostic radiopharmaceutical administration
Typical site of service: Hospital outpatient imaging department, outpatient nuclear medicine facility, or ambulatory imaging center

Data not available in the input.

Explore openpayer tools

View all tools

Find policies, billing codes, payers, states, and providers

HCPCS A9596: Gallium Ga-68 Gozetotide (Illuccix), Diagnostic, 1 mCi

Customize your policy alerts

Sign up for hcpcs A9596 policy alerts

Get alerted when payer policies referencing A9596 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

Service type: Diagnostic radiopharmaceutical administration
Typical site of service: Hospital outpatient imaging department, outpatient nuclear medicine facility, or ambulatory imaging center

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a history of treated prostate cancer presents with rising prostate-specific antigen (PSA) and suspicion for recurrent or metastatic disease. The referring medical oncologist orders a diagnostic PET scan using A9596 (Gallium Ga-68 gozetotide, diagnostic, (Illuccix), 1 millicurie) to localize somatostatin receptor–expressing lesions for restaging. The typical clinical workflow: the radiology or nuclear medicine clinic verifies indication and performs pre-procedure screening, obtains informed consent, and confirms recent laboratory tests and allergy history. The technologist prepares and administers the radiopharmaceutical A9596 intravenously in the nuclear medicine injection area. The patient rests per protocol to allow tracer distribution, then proceeds to PET/CT imaging in the nuclear medicine suite. Images are reconstructed and interpreted by a nuclear medicine physician or radiologist; a diagnostic report is generated and communicated to the referring provider. Typical sites of service are an outpatient hospital imaging department, ambulatory imaging center, or a hospital inpatient nuclear medicine department when inpatient staging is required. Common patient scenarios include biochemical recurrence of prostate cancer, staging for suspected neuroendocrine tumors, or evaluation of localized disease when conventional imaging is inconclusive.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	Routine reporting when no modifier is applicable
`22`	Unusual procedural services	When work required is substantially greater than typical for the procedure (rare for radiopharmaceutical dispensing/administration)
`23`	Unusual anesthesia	When medically necessary anesthesia is provided for an otherwise non-anesthetic procedure
`52`	Reduced services	If only a partial dose or abbreviated imaging protocol is performed
`53`	Discontinued procedure	When the administration or imaging is started but stopped for patient safety or other valid reasons
`62`	Two surgeons	When two physicians of different specialties share performance responsibility (rare for radiopharmacy but applicable if shared procedural care occurs)
`78`	Unplanned return to OR/procedure	For an unplanned repeat interventional procedure related to complications (uncommon for diagnostic radiopharmaceuticals)
`80`	Assistant surgeon	When an assistant surgeon is legitimately required (rare for diagnostic PET administration)
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	When a PA/NP/CNS performs or assists in administration under state law and payor policy
`JW`	Drug discarded/not administered to any patient	When part of the `A9596` vial is discarded and reporting of waste is required by payor
`JZ`	No drug wastage (no waste)	When an entire unit of `A9596` is used with no waste
`QX`	CRNA service with medical direction by physician	If a certified registered nurse anesthetist provides anesthesia for the procedure under medical direction
`QY`	Medical direction of two, three, or four anesthesia procedures	When the physician medically directs multiple anesthesia procedures during the imaging session
`UD`	Urine drug screen (facility-specific)	When facility-specific urine or point-of-care testing is performed prior to imaging (used per facility policy)

Taxonomy Code	Specialty	Notes
`2084P0800X`	Nuclear Medicine Physician	Interprets PET/CT images and supervises radiopharmaceutical administration
`207RC0000X`	Diagnostic Radiology	Radiologist who may interpret fused PET/CT studies and provide diagnostic correlation
`364S00000X`	Radiology Technician (Nuclear Medicine Technologist)	Prepares and administers radiopharmaceutical, performs imaging acquisition
`208D00000X`	Interventional Radiology (when applicable)	Involved if image-guided biopsy or intervention is planned in same encounter
`163WL0500X`	Medical Oncology	Refers and uses PET results for cancer staging and treatment planning

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C61`	Malignant neoplasm of prostate	Common indication for Ga-68 prostate-specific membrane antigen (PSMA)–targeted PET imaging to detect recurrent or metastatic disease
`C77.0`	Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck	Lymph node metastasis localization may be assessed with PET imaging using `A9596`
`C79.5`	Secondary malignant neoplasm of bone	Bone metastases from prostate cancer or other tumors are routinely evaluated with PET/CT after `A9596` administration
`D37.9`	Neoplasm of uncertain or unknown behavior of urinary system	Used when localization or characterization of suspected prostate/urothelial lesions is required
`R97.2`	Elevated prostate specific antigen (PSA)	Biochemical recurrence prompting PSMA-targeted PET with `A9596` to localize disease
`C7A.89`	Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue	When evaluating unusual metastatic patterns or neuroendocrine-type lesions that may express target receptors

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78813`	PET imaging, tumor, single area; with concurrently acquired CT for attenuation correction and anatomic localization, including imaging supervision, interpretation, and report	Common PET/CT acquisition code used when `A9596` is administered for tumor localization in a single region
`78816`	PET imaging, tumor, multiple areas; with concurrently acquired CT for attenuation correction and anatomic localization, including imaging supervision, interpretation, and report	Used when whole-body or multiple-region PET/CT imaging is performed after administration of `A9596`
`78815`	PET imaging, tumor; whole body, with concurrently acquired CT for attenuation correction and anatomic localization, including imaging supervision, interpretation, and report	Applicable for whole-body staging protocols following `A9596` administration
`79705`	Injection procedure for administration of radiopharmaceutical agent via intravenous route (includes venous access)	Procedure code for the intravenous injection of `A9596` when separately reportable under payer policy
`76376`	CT attenuation correction and anatomic localization for PET/CT, performed in conjunction with PET	Describes the CT component used for attenuation correction and anatomic localization of PET images acquired after `A9596` administration

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.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Explore openpayer tools

View all tools

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	Routine reporting when no modifier is applicable
`22`	Unusual procedural services	When work required is substantially greater than typical for the procedure (rare for radiopharmaceutical dispensing/administration)
`23`	Unusual anesthesia	When medically necessary anesthesia is provided for an otherwise non-anesthetic procedure
`52`	Reduced services	If only a partial dose or abbreviated imaging protocol is performed
`53`	Discontinued procedure	When the administration or imaging is started but stopped for patient safety or other valid reasons
`62`	Two surgeons	When two physicians of different specialties share performance responsibility (rare for radiopharmacy but applicable if shared procedural care occurs)
`78`	Unplanned return to OR/procedure	For an unplanned repeat interventional procedure related to complications (uncommon for diagnostic radiopharmaceuticals)
`80`	Assistant surgeon	When an assistant surgeon is legitimately required (rare for diagnostic PET administration)
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	When a PA/NP/CNS performs or assists in administration under state law and payor policy
`JW`	Drug discarded/not administered to any patient	When part of the `A9596` vial is discarded and reporting of waste is required by payor
`JZ`	No drug wastage (no waste)	When an entire unit of `A9596` is used with no waste
`QX`	CRNA service with medical direction by physician	If a certified registered nurse anesthetist provides anesthesia for the procedure under medical direction
`QY`	Medical direction of two, three, or four anesthesia procedures	When the physician medically directs multiple anesthesia procedures during the imaging session
`UD`	Urine drug screen (facility-specific)	When facility-specific urine or point-of-care testing is performed prior to imaging (used per facility policy)

Taxonomy Code	Specialty	Notes
`2084P0800X`	Nuclear Medicine Physician	Interprets PET/CT images and supervises radiopharmaceutical administration
`207RC0000X`	Diagnostic Radiology	Radiologist who may interpret fused PET/CT studies and provide diagnostic correlation
`364S00000X`	Radiology Technician (Nuclear Medicine Technologist)	Prepares and administers radiopharmaceutical, performs imaging acquisition
`208D00000X`	Interventional Radiology (when applicable)	Involved if image-guided biopsy or intervention is planned in same encounter
`163WL0500X`	Medical Oncology	Refers and uses PET results for cancer staging and treatment planning

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C61`	Malignant neoplasm of prostate	Common indication for Ga-68 prostate-specific membrane antigen (PSMA)–targeted PET imaging to detect recurrent or metastatic disease
`C77.0`	Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck	Lymph node metastasis localization may be assessed with PET imaging using `A9596`
`C79.5`	Secondary malignant neoplasm of bone	Bone metastases from prostate cancer or other tumors are routinely evaluated with PET/CT after `A9596` administration
`D37.9`	Neoplasm of uncertain or unknown behavior of urinary system	Used when localization or characterization of suspected prostate/urothelial lesions is required
`R97.2`	Elevated prostate specific antigen (PSA)	Biochemical recurrence prompting PSMA-targeted PET with `A9596` to localize disease
`C7A.89`	Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue	When evaluating unusual metastatic patterns or neuroendocrine-type lesions that may express target receptors

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78813`	PET imaging, tumor, single area; with concurrently acquired CT for attenuation correction and anatomic localization, including imaging supervision, interpretation, and report	Common PET/CT acquisition code used when `A9596` is administered for tumor localization in a single region
`78816`	PET imaging, tumor, multiple areas; with concurrently acquired CT for attenuation correction and anatomic localization, including imaging supervision, interpretation, and report	Used when whole-body or multiple-region PET/CT imaging is performed after administration of `A9596`
`78815`	PET imaging, tumor; whole body, with concurrently acquired CT for attenuation correction and anatomic localization, including imaging supervision, interpretation, and report	Applicable for whole-body staging protocols following `A9596` administration
`79705`	Injection procedure for administration of radiopharmaceutical agent via intravenous route (includes venous access)	Procedure code for the intravenous injection of `A9596` when separately reportable under payer policy
`76376`	CT attenuation correction and anatomic localization for PET/CT, performed in conjunction with PET	Describes the CT component used for attenuation correction and anatomic localization of PET images acquired after `A9596` administration

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.