Summary & Overview
HCPCS A9611: Flurpiridaz F 18 Diagnostic Radiopharmaceutical, 1 millicurie
HCPCS Level II code A9611 represents a diagnostic dose of Flurpiridaz F 18 (1 millicurie), a radiopharmaceutical used in nuclear medicine imaging. This code is nationally relevant as it identifies a specific diagnostic agent increasingly used in myocardial perfusion imaging and other PET-based diagnostic studies, affecting billing, coverage, and access across payers. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, typical sites of service, and the payer landscape. The publication summarizes common modifiers and service-line considerations, highlights benchmark and coverage patterns where available, and outlines policy and reimbursement implications relevant to hospitals, imaging centers, and nuclear medicine providers. This summary provides clinicians, billing professionals, and policy analysts with the information needed to identify the code, understand its use in diagnostic PET imaging, and locate payer-specific guidance and benchmarks for coverage and billing practice. Data not available in the input are flagged accordingly in detailed sections.
Billing Code Overview
HCPCS Level II code A9611 describes Flurpiridaz F 18, diagnostic, 1 millicurie. This code represents a radiopharmaceutical dose of Flurpiridaz F 18 used for diagnostic imaging. The service type is a nuclear medicine diagnostic radiopharmaceutical administration and the typical site of service is an outpatient imaging center or hospital nuclear medicine department.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred for PET myocardial perfusion imaging using A9611 (Flurpiridaz F 18, diagnostic, 1 millicurie) to evaluate suspected or known coronary artery disease. The patient presents with exertional chest pain or equivocal stress test results and is scheduled for a pharmacologic or exercise stress PET study. Pre-procedure workflow includes verification of order, review of indications and allergies, pregnancy status for women of childbearing potential, and obtaining informed consent. On the day of service, an intravenous line is placed, baseline vitals are recorded, and the patient undergoes either exercise or pharmacologic stress (e.g., regadenoson). At peak stress or appropriate time point, the technologist administers A9611 per radiopharmacy dosing protocol. The PET acquisition is performed by nuclear medicine or cardiology imaging staff, images are processed and interpreted by a credentialed physician (nuclear cardiologist or nuclear medicine physician), and a diagnostic report is generated. Post-procedure monitoring occurs for adverse reactions; the patient is discharged with follow-up instructions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | Use for routine administration when no special circumstances apply. |