Summary & Overview
HCPCS A9616: Gallium Ga-68 Gozetotide, Diagnostic, 1 Millicurie
HCPCS Level II code A9616 designates a 1 millicurie unit of Gallium Ga-68 gozetotide (gozellix), a PET radiopharmaceutical used for diagnostic molecular imaging. This radiotracer is increasingly relevant as PET imaging expands for oncologic and other diagnostic indications; precise coding supports appropriate billing, tracking of radiopharmaceutical utilization, and payer coverage determinations nationally. Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical role, typical sites of service, and the payer landscape affecting coverage and claims processing. The publication summarizes common modifiers observed in practice, outlines where this service is usually delivered (imaging centers and hospital outpatient departments), and highlights the administrative considerations tied to radiopharmaceutical dosing units. The content provides benchmarks and policy-oriented context where available, explains billing implications for the service line, and identifies gaps when source data were not provided. This summary is written for a national audience interested in coding accuracy, payer policy alignment, and operational implications for radiology and nuclear medicine providers.
Billing Code Overview
HCPCS Level II code A9616 represents Gallium Ga-68 gozetotide (gozellix), diagnostic, 1 millicurie. This code covers the radiopharmaceutical agent used for diagnostic molecular imaging studies that utilize gallium Ga-68 gozetotide as the tracer.
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Service type: Diagnostic radiopharmaceutical administration for PET imaging
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Typical site of service: Imaging centers or hospital outpatient settings where positron emission tomography (PET) diagnostic procedures are performed
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with known or suspected somatostatin receptor–expressing neuroendocrine tumor (NET) who is referred for PET imaging using A9616 (Gallium Ga-68 gozetotide, diagnostic, 1 millicurie) to localize primary tumor, evaluate metastatic disease, or assess suitability for peptide receptor radionuclide therapy (PRRT). The clinical workflow: outpatient or inpatient referral from medical oncology, endocrinology, or surgery; pre-procedure verification of indication and allergies; intravenous administration of A9616 radiotracer by a nuclear medicine technologist or radiopharmacist; uptake period (typically 45–90 minutes) during which the patient remains in clinical observation; PET/CT acquisition by nuclear medicine; image reconstruction and interpretation by a nuclear medicine physician or radiologist with subspecialty expertise in oncologic PET; result reporting and treatment planning discussion with the referring clinician. Typical sites of service include hospital outpatient imaging centers, freestanding PET/CT imaging centers, and tertiary care centers with nuclear medicine capabilities. Common clinical scenarios include staging of newly diagnosed NET, restaging after therapy, detection of occult primary in metastatic disease, and assessment prior to PRRT eligibility evaluation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |