Summary & Overview
HCPCS C9407: Iodine I-131 Iobenguane, Diagnostic, 1 mCi
HCPCS Level II code C9407 identifies a diagnostic radiopharmaceutical: Iodine I-131 iobenguane at a 1 millicurie activity used in nuclear medicine imaging. This agent is used for diagnostic evaluation, typically in imaging centers, hospital outpatient departments, and nuclear medicine facilities to localize neuroendocrine tumors or adrenal medullary tissue where iobenguane uptake is informative. Nationally, accurate coding of radiopharmaceuticals like C9407 is important for consistent clinical documentation, appropriate billing, and coverage determinations across payers.
Key payers considered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of what the code represents, clinical context for its diagnostic use, and the typical sites of service where it is administered. The publication outlines benchmarking and coverage considerations, highlights relevant clinical context for ordering and use, and notes where input data are not available. This summary serves clinicians, coding professionals, and policy analysts seeking a national perspective on coding and clinical application of this radiopharmaceutical diagnostic code.
Billing Code Overview
HCPCS Level II code C9407 describes Iodine I-131 iobenguane, diagnostic, 1 millicurie. This code represents the diagnostic radiopharmaceutical formulation of iobenguane labeled with iodine-131 at a 1 millicurie activity.
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Service type: Diagnostic radiopharmaceutical administration for nuclear medicine imaging
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Typical site of service: Hospital outpatient departments, outpatient imaging centers, and nuclear medicine facilities
Data not available in the input for modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A typical patient for C9407 is an adult or pediatric patient with suspected or known neuroendocrine tumors (most commonly pheochromocytoma or paraganglioma) who requires diagnostic localization using radiolabeled meta-iodobenzylguanidine (iobenguane I‑131). The clinical workflow: the ordering physician (often an endocrinologist, nuclear medicine physician, or oncologist) documents the indication (e.g., biochemical evidence of catecholamine-secreting tumor or staging/restaging of known disease). The patient receives pre-test screening for pregnancy and recent iodine or contrast exposures, medication adjustments to avoid interference with uptake, and thyroid blockade (e.g., saturated potassium iodide or potassium perchlorate) to protect the thyroid prior to administration. On the day of service, the nuclear medicine technologist administers the diagnostic dose of I-131 iobenguane (1 millicurie) under the supervision of the nuclear medicine physician. Post-injection imaging (planar and/or SPECT/CT) is performed at institution-specific timepoints (commonly 24–72 hours post-dose) to localize tracer uptake. The nuclear medicine physician interprets images and provides a report documenting focal or diffuse uptake consistent with neuroendocrine tumor, metastatic disease, or negative/physiologic distribution. Results are routed back to the ordering clinician for management decisions, which may include further imaging, biopsy, surgical planning, or consideration of therapeutic I‑131 MIBG if diagnostic imaging confirms targetable disease.
Coding Specifications
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