HCPCS A9608: Flotufolastat F 18 Diagnostic, 1 Millicurie

HCPCS Level II code A9608 identifies Flotufolastat F 18, a diagnostic radiopharmaceutical dosed at 1 millicurie, used in nuclear medicine imaging. This code covers the radiopharmaceutical vial or dose rather than the imaging procedure itself and is relevant to facilities managing PET/SPECT diagnostic services. Nationally, radiopharmaceutical coding like A9608 matters for accurate billing, inventory control, and tracking of high-cost diagnostic agents.

Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise examination of what A9608 represents clinically and operationally, and a summary of payer coverage patterns where available. The publication outlines typical sites of service, common billing considerations tied to radiopharmaceuticals, and where to look for related reimbursement and policy updates.

This summary prepares clinicians, hospital billing teams, and policy analysts to understand the clinical role of Flotufolastat F 18 and the billing context for A9608, including benchmarking references and recent policy directions that affect radiopharmaceutical billing nationally.

Billing Code Overview

HCPCS Level II code A9608 represents Flotufolastat F 18, diagnostic, 1 millicurie, a radiopharmaceutical diagnostic agent labeled by millicurie. The service type is a diagnostic nuclear medicine radiopharmaceutical administration used to image or evaluate disease processes using positron emission. The typical site of service for this radiopharmaceutical is outpatient imaging centers, hospital-based nuclear medicine departments, or clinics equipped for PET/SPECT diagnostic studies.

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Clinical Context

A typical patient is an adult with suspected prostate cancer recurrence or metastatic prostate disease who is referred for a PET diagnostic nuclear medicine scan using A9608 (flotufolastat F 18, diagnostic, 1 millicurie). The clinical workflow begins with outpatient referral from a urologist or medical oncologist after rising prostate-specific antigen (PSA) or equivocal cross-sectional imaging. Pre-procedure steps include verification of indication, review of prior imaging, medication reconciliation, and informed consent for a radiopharmaceutical injection. On the day of service the patient arrives to an outpatient imaging center or hospital nuclear medicine department. Intravenous access is obtained, the calculated activity of flotufolastat F 18 is drawn and administered, and the patient is observed for immediate adverse reactions. After an uptake period consistent with institutional protocol (typically about 60 minutes), PET/CT imaging is performed by a nuclear medicine technologist under supervision of a nuclear medicine physician or radiologist. Post-scan, images are processed, interpreted by the physician, and a formal report documenting radiopharmaceutical, administered activity, findings, and impression is generated for the referring clinician. Typical sites of service include outpatient imaging centers, hospital outpatient departments, and ambulatory surgery centers equipped for diagnostic PET imaging. Common clinical use-case: biochemical recurrence evaluation in prostate cancer, staging for suspected metastatic disease, or localization of PSMA-expressing lesions prior to targeted therapy selection.

Coding Specifications

Modifier	Description	When to Use

Taxonomy Code	Specialty	Notes
2085R0200X	Nuclear Medicine Physician	Interprets PET radiopharmaceutical imaging and supervises administration.
207RG0100X	Diagnostic Radiology	Reads PET/CT studies, integrates cross-sectional CT interpretation.
2086S0200X	Nuclear Medicine Technologist	Performs radiopharmaceutical preparation and PET/CT acquisition.
363LF0000X	Nurse Practitioner	May obtain consent, perform pre-procedure assessment, and assist in patient management.
367500000X	Physician Assistant	May support clinical workflow, IV placement, and documentation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C61`	Malignant neoplasm of prostate	Primary indication for PSMA-targeted PET imaging with `A9608` to detect local recurrence or metastases.
`R97.20`	Elevated prostate specific antigen [PSA], unspecified	Common trigger for PET imaging to localize site of biochemical recurrence.
`C79.51`	Secondary malignant neoplasm of bone	PET imaging evaluates osseous metastatic disease in prostate cancer staging.
`C79.82`	Secondary malignant neoplasm of adrenal gland	Identifies uncommon metastatic sites on targeted PET imaging.
`Z85.46`	Personal history of prostate cancer	Used for surveillance and localization of recurrent disease with PET imaging.
`N40`	Benign prostatic hyperplasia	Differentiation from malignancy may be part of clinical assessment, though PET is primarily for malignant disease.
`M84.50XA`	Pathologic fracture, site unspecified, initial encounter	Imaging may be performed to evaluate suspected pathologic fracture from metastatic prostate cancer.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78815`	Positron emission tomography (PET) imaging; skull base to mid-thigh	Common PET acquisition code used when `A9608` radiotracer is imaged across standard whole-body range.
`78816`	PET imaging, whole body, including skull base to toes	Used for extended whole-body PET imaging when clinical indication requires head-to-toe coverage.
`78811`	Radiopharmaceutical localization of tumor, single area imaging	Used for limited field PET imaging when only a focal region is imaged after administration of radiopharmaceutical.
`76376`	3D rendering with interpretation and report, not resulting from a CT/MR; assistance in PET/CT post-processing	Used when advanced 3D PET image processing or fusion is performed for surgical or radiation planning.
`77012`	CT guidance for localization and radiation treatment planning (when non-contrast CT used for PET/CT attenuation correction)	Applied when the CT portion is used for treatment planning or requires separate technical reporting.

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Summary & Overview