Summary & Overview

HCPCS Level II C9176: Tc-99m from Domestic Non-HEU Mo-99, Cost Recovery Add-On

HCPCS Level II code C9176 identifies a full cost recovery add‑on for a per‑study dose of technetium‑99m derived from domestically produced non‑HEU molybdenum‑99 (minimum 50%). This code matters nationally as supply chain shifts toward non‑HEU Mo‑99 production and efforts to ensure sustainable domestic radiopharmaceutical supplies affect pricing, hospital budgeting, and access to nuclear medicine services. The add‑on nature of the code targets the radiopharmaceutical component of nuclear imaging and therapy rather than technical or professional service components.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for how this add‑on is handled in payer reimbursement policies, summaries of relevant policy updates affecting radiopharmaceutical sourcing and cost recovery, and clinical context describing where the add‑on applies within nuclear medicine service lines. The publication outlines typical sites of service and operational considerations for billing but does not provide clinical recommendations. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC9176HCPCS Level IInuclear medicinetechnetium-99mradiopharmaceuticalsMo-99cost recoveryadd-on codehospital outpatient

Billing Code Overview

HCPCS Level II code C9176 denotes Tc-99m derived from domestically produced non‑HEU Mo‑99 (minimum 50 percent), full cost recovery add‑on, per study dose. This code is intended to represent an add‑on supply component for nuclear medicine studies where technetium‑99m sourced from non‑highly enriched uranium molybdenum‑99 is used and a full cost recovery adjustment is applied on a per‑study‑dose basis.

Service Type: Nuclear medicine radiopharmaceutical add‑on.

Typical Site of Service: Hospital outpatient departments, hospital inpatient nuclear medicine departments, and freestanding imaging centers that perform diagnostic or therapeutic nuclear medicine studies.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult undergoing a diagnostic nuclear medicine study requiring technetium-99m (Tc-99m) radiopharmaceutical labeled material. The facility has procured Tc-99m produced from domestically sourced, non-HEU molybdenum-99 (Mo-99) and bills an add-on charge for full cost recovery per study dose under C9176. The patient is referred from outpatient nuclear medicine, cardiology, oncology, or orthopedics for imaging such as bone scan, renal scan, hepatobiliary study, or myocardial perfusion imaging.

Workflow:

Patient scheduled at an outpatient imaging center or hospital nuclear medicine department.
Radiopharmacy verifies availability of domestically produced non-HEU Mo-99–derived Tc-99m and prepares the study dose per routine sterile compounding and radiolabeling protocols.
Patient arrives, identity and indications are confirmed; intravenous access or oral/voiding instructions are performed as appropriate for the specific scan.
Radiopharmacist documents lot numbers, activity, and C9176 is added to billing as the per study dose add-on for the higher-cost domestically derived Tc-99m.
Nuclear medicine technologist administers the Tc-99m radiopharmaceutical; imaging is performed per protocol (timing, camera acquisition, SPECT/SPECT-CT or planar as indicated).
Images are interpreted by a nuclear medicine physician or radiologist; results documented and reported to the referring clinician.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing physician interpretation of the imaging study separate from facility services.
`TC`	Technical component	Use when billing only the facility/technical portion of the imaging study, including radiopharmaceutical supply and imaging equipment use.
`Q0`	Investigational clinical service provided in a clinical research study, not otherwise specified	Use when the radiopharmaceutical is provided under an approved clinical trial protocol and not separately paid.
`Q1`	Investigational clinical service provided in a clinical research study, paid	Use when the investigational service is paid outside the research protocol.
`JW`	Drug amount discarded/not administered	Use if part of a multi-dose vial dose is discarded and reporting of discarded portion is required (where applicable for radiopharmaceutical inventory reporting).
`GN`	Services of a speech-language pathologist	Not typically applicable to this procedure; not used routinely but listed for completeness if multidisciplinary coding applies.
`GP`	Physical therapy services	Not applicable to radiopharmaceutical billing; not routinely used.
`59`	Distinct procedural service	Use when another separate, distinct procedure is performed on the same day requiring separate billing from the nuclear medicine study.
`XE`	Separate encounter, a service that is distinct because it occurred during a separate encounter	Use when the radiopharmaceutical dose administration occurred during a separate encounter from another billed service.
`XP`	Separate practitioner, distinct practitioner who is not in the same group or specialty	Use when a different practitioner bills separately for an element of the service distinct from the facility or interpreting physician.

Taxonomy Code	Specialty	Notes
`2085R0200X`	Nuclear Medicine Physician	Interprets nuclear medicine studies and oversees radiopharmaceutical use.
`208C00000X`	Diagnostic Radiology	Radiologists who interpret nuclear medicine and hybrid imaging studies.
`3336C0001X`	Radiopharmacist	Prepares and compounds radiopharmaceutical doses, documents lot and source information.
`331K00000X`	Nuclear Medicine Technologist	Administers radiopharmaceuticals and performs image acquisition.
`207K00000X`	Internal Medicine	Referring specialty commonly ordering `Tc-99m` studies for metabolic, renal, or cardiac indications.

ICD-10 Code	Description	Clinical Relevance
`C79.51`	Secondary malignant neoplasm of bone	Indication for `Tc-99m` bone scintigraphy to evaluate suspected osseous metastases.
`M25.50`	Pain in unspecified joint	Evaluation of unexplained focal bone or joint pain may include `Tc-99m` bone scan.
`N20.0`	Calculus of kidney	Renal scintigraphy with `Tc-99m` agents can assess obstruction or differential function when nephrolithiasis is suspected.
`R94.5`	Abnormal results of liver function studies	Hepatobiliary imaging with `Tc-99m` compounds may be used to evaluate biliary obstruction or acute cholecystitis.
`I25.110`	Atherosclerotic heart disease of native coronary artery with unstable angina pectoris	Myocardial perfusion imaging with `Tc-99m` radiotracers assesses ischemia and perfusion abnormalities.

CPT Code	Description	Relationship to This Procedure
`78803`	Bone imaging, whole body; single or multiple areas (planar)	Commonly performed using `Tc-99m` radiopharmaceuticals; the `C9176` add-on would apply per study dose when domestically produced non-HEU Mo-99–derived `Tc-99m` is used.
`78801`	Radionuclide imaging, limited area (e.g., spot views), planar	Used for smaller or focused bone or other organ imaging studies that may use `Tc-99m` doses billed with `C9176`.
`78452`	Myocardial perfusion imaging, single study, planar or SPECT; including pharmacologic stress when performed	`Tc-99m` radiopharmaceuticals are commonly used for myocardial perfusion studies; `C9176` may be billed per injected dose.
`78700`	Hepatobiliary imaging (HIDA), includes radiopharmaceutical	HIDA studies utilize `Tc-99m` agents and are performed with a per-study dose that may incur the `C9176` add-on.
`78706`	Renal imaging, including qualitative and quantitative studies	Renal scintigraphy employs `Tc-99m` agents; `C9176` is related as the radiopharmaceutical cost add-on per study dose.

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