Summary & Overview
HCPCS C9156: Flotufolastat F 18 Diagnostic Dose, 1 mCi
HCPCS Level II code C9156 designates a diagnostic dose of Flotufolastat F 18 (1 millicurie), a radiopharmaceutical used in nuclear medicine imaging. This code is relevant nationally as introduction of new diagnostic radiotracers affects imaging protocols, payer coverage decisions, and facility billing practices across outpatient imaging centers and hospital nuclear medicine departments. The adoption and coverage determination for such agents influence access to diagnostic services and claims processing at scale.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find national benchmarks for coding and billing practice, summaries of coverage considerations, and clinical context for when a diagnostic Flotufolastat F 18 dose is used. The publication outlines typical service settings, common modifiers and procedural considerations (listed elsewhere), and highlights areas where payer policies and medical necessity criteria commonly intersect with radiopharmaceutical use.
This summary provides an overview of what stakeholders need to know about HCPCS Level II code C9156: its clinical role in diagnostic imaging, the payer landscape, and the types of operational and policy information that follow in the full publication. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
HCPCS Level II code C9156 represents Flotufolastat F 18, diagnostic, 1 millicurie. This code describes a diagnostic radiopharmaceutical dose used for imaging procedures that employ the radiotracer Flotufolastat F 18 at a 1 millicurie activity level.
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Service type: Diagnostic radiopharmaceutical administration for nuclear medicine imaging
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Typical site of service: Outpatient imaging centers and hospital-based nuclear medicine departments
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with suspected or known prostate cancer being evaluated for metastatic disease using a PET imaging study. The patient presents to an outpatient nuclear medicine or radiology department after referral from a urology or medical oncology clinic because of rising prostate-specific antigen (PSA) levels, biochemical recurrence after primary therapy, or staging of high-risk disease. The clinical workflow includes preauthorization and scheduling, a pre-scan clinical assessment and medication review, administration of the radiopharmaceutical C9156 (Flotufolastat F 18, diagnostic, 1 millicurie) by a licensed nuclear medicine technologist or authorized provider, an appropriate uptake period, PET/CT or PET/MRI image acquisition by technologists under physician protocol, and image interpretation by a board-certified nuclear medicine physician or radiologist. Documentation includes the drug name and amount administered, route, date/time of administration, lot number, and any administered modifiers, along with the diagnostic indication such as biochemical recurrence or staging. Typical sites of service are outpatient hospital-based imaging centers, freestanding diagnostic imaging centers, and ambulatory surgical centers with nuclear medicine capabilities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to prepare or administer the radiopharmaceutical substantially exceeds usual requirements (rare for routine radiotracer administration). |