Summary & Overview
HCPCS A9800: Gallium ga-68 gozetotide (locametz), Diagnostic, 1 millicurie
HCPCS Level II code A9800 denotes a 1 millicurie dose of Gallium ga-68 gozetotide (locametz), a PET radiopharmaceutical used for diagnostic molecular imaging. This code captures a specific diagnostic agent increasingly used in oncologic imaging to localize disease and guide clinical decision-making. Standardized coding for novel radiopharmaceuticals matters nationally as it affects coverage determinations, billing consistency, and access to advanced imaging.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of payer coverage patterns, national reimbursement benchmarks where available, and the clinical context for using this agent in PET imaging workflows. The publication outlines common billing considerations, coding adjacencies, and service-line placement for imaging departments.
The content provides practical reference material: definition and intended use of the code, typical sites of service, payer landscape, and the types of benchmarks and policy updates readers can expect to consult when evaluating adoption and billing for this diagnostic radiopharmaceutical. Data not available in the input is explicitly noted where relevant.
Billing Code Overview
HCPCS Level II code A9800 describes Gallium ga-68 gozetotide, diagnostic, (locametz), 1 millicurie. This billing code represents a radiopharmaceutical dose used for diagnostic molecular imaging, specifically a gallium-68–labeled PET imaging agent.
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Service type: Diagnostic radiopharmaceutical for positron emission tomography (PET) imaging
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Typical site of service: Outpatient imaging centers, hospital outpatient departments, and nuclear medicine departments
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with known or suspected prostate cancer referred for a PET/CT scan using Gallium Ga-68 gozetotide (LOCAMETZ) to localize somatostatin receptor–expressing lesions or prostate-specific membrane antigen (PSMA)-expressing disease depending on clinical indication. The procedure is ordered by a medical oncologist, urologist, or nuclear medicine physician after rising prostate-specific antigen (PSA) following prior therapy or when biochemical recurrence is suspected. The workflow includes: referral and review of prior imaging and oncologic history; verification of indication and informed consent; radiopharmacy preparation and calibration of one-millicurie (1 mCi) unit dose of A9800 material; patient arrival, verification of identity and pregnancy status, and radiotracer administration via IV by a qualified nuclear medicine technologist or nurse; appropriate uptake period in a monitored area; PET/CT acquisition by nuclear medicine technologist under physician supervision; image reconstruction and interpretation by the nuclear medicine physician; and documentation of findings in the radiology report. Typical site of service is an outpatient radiology or nuclear medicine facility, hospital outpatient department, or freestanding imaging center equipped for PET/CT and handling radiopharmaceuticals.
Coding Specifications
| Modifier | Description | When to Use |
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