C9459 Flutemetamol F‑18 Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS C9459: Flutemetamol F-18 Diagnostic PET Dose

HCPCS Level II code C9459 designates flutemetamol F-18 provided as a diagnostic radiopharmaceutical dose (up to 5 millicuries) for PET brain imaging. This agent is used to support visualization of cerebral pathology and is relevant in the diagnostic evaluation of neurodegenerative conditions and other brain disorders where PET amyloid imaging or related physiology-focused studies are indicated. Nationally, radiopharmaceutical codes like C9459 are important for consistent billing, coverage determinations, and tracking utilization of advanced diagnostic imaging.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for flutemetamol F-18, common sites where the service is delivered, and what to expect in payer coverage conversations. The publication outlines reimbursement benchmarks, typical claim considerations for radiopharmaceuticals, and any recent policy updates affecting HCPCS Level II radiopharmaceutical coding where available. It also summarizes how C9459 fits into imaging service lines and operational workflows for hospitals and outpatient imaging centers.

Data not available in the input for detailed modifiers, associated taxonomies, specific ICD-10 diagnoses, payer-specific coverage rules, and related codes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC9459HCPCS Level IIflutemetamolradiopharmaceuticalPET imagingnuclear medicinediagnostic imaging

Billing Code Overview

HCPCS Level II code C9459 refers to Flutemetamol F-18, a radiopharmaceutical supplied for diagnostic PET imaging, described as "Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries". This service is a diagnostic nuclear medicine imaging agent used to visualize physiological processes in the brain.

Service type: Nuclear medicine diagnostic radiopharmaceutical for PET imaging

Typical site of service: Hospital outpatient departments, imaging centers, and specialized PET clinics

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult referred for brain amyloid imaging to evaluate suspected Alzheimer disease or other causes of cognitive decline. The patient presents to an outpatient nuclear medicine or PET imaging center. Pre-procedure steps include review of clinical indications (progressive memory loss, MCI, or atypical dementia), obtaining consent, assessment of contraindications (pregnancy, breastfeeding), and verification of the ordering physician’s documentation. On the day of service, an intravenous line is placed, and the radiopharmaceutical C9459 (flutemetamol F18, up to 5 mCi per study dose) is administered. After the recommended uptake period, PET imaging of the brain is performed per facility protocol. Post-procedure, images are processed and interpreted by a qualified nuclear medicine physician or neuroradiologist, and a diagnostic report is transmitted to the referring clinician for correlation with clinical findings and management planning.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician interpretation for the PET study separate from technical services provided by the facility.
`TC`

HCPCS C1825: Implantable Neurostimulator Generator, Carotid Sinus Baroreceptor

HCPCS-C7523-CORONARY-CATHETERIZATION-WITH-INTRAVASCULAR-IMAGING

HCPCS C7523: Coronary Catheterization with IVUS/OCT

HCPCS-C9026-VEDOLIZUMAB-INJECTION-1MG

HCPCS C9026: Injection, Vedolizumab, 1 mg

HCPCS-C9168-MIRIKIZUMAB-INJECTION-1MG

HCPCS Level II C9168: Injection, mirikizumab-mrkz, 1 mg

HCPCS-C8937-BREAST-MRI-COMPUTER-AIDED-DETECTION-PHARMACOKINETIC-ANALYSIS

HCPCS C8937: Breast MRI Computer-Aided Detection with Pharmacokinetic Analysis

HCPCS-C9023-TESTOSTERONE-UNDECANOATE-INJECTION-1MG

HCPCS C9023: Injection, Testosterone Undecanoate, 1 mg

HCPCS-C2618-CRYOABLATION-PROBE-NEEDLE

HCPCS C2618: Cryoablation Probe/Needle

HCPCS-C1719-BRACHYTHERAPY-IRIDIUM-192-SOURCE-NON-STRANDED

HCPCS C1719: Brachytherapy Source, Iridium-192, Non-Stranded

HCPCS-C7528-CORONARY-ANGIOGRAPHY-WITH-FLOW-RESERVE-MEASUREMENT

HCPCS C7528: Coronary Angiography with Intravascular Flow Reserve Measurement

HCPCS-C9449-BLINATUMOMAB-INJECTION-1-MCG

HCPCS C9449: Blinatumomab Injection, 1 mcg

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Taxonomy Code	Specialty	Notes
`207K00000X`	Nuclear Medicine Physician	Interprets PET amyloid imaging and provides diagnostic correlation.
`2084P0800X`	Neuroradiology	Subspecialty interpreting brain PET/CT or PET/MRI studies for cognitive disorders.
`246M00000X`	Radiology	May perform and interpret PET imaging in some practices.
`174400000X`	Registered Nuclear Medicine Technologist	Performs radiopharmaceutical administration and image acquisition; listed as a provider role when applicable.
`362A00000X`	Clinical Nuclear Medicine Technologist	Directly involved in radiopharmaceutical preparation and scanning protocols.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G30.0`	Alzheimer disease with early onset	Amyloid PET imaging can be used to detect cerebral amyloid in patients with suspected early-onset Alzheimer disease for diagnostic clarification.
`G30.1`	Alzheimer disease with late onset	Used when evaluating typical late-onset Alzheimer disease presentations where amyloid imaging may assist diagnosis.
`G31.84`	Mild cognitive impairment, so stated	Amyloid PET can help risk-stratify patients with MCI to determine likelihood of underlying Alzheimer pathology.
`F02.80`	Dementia in other diseases classified elsewhere without behavioral disturbance	Employed when dementia is present with suspected Alzheimer pathology in the context of other conditions; imaging may aid differential diagnosis.
`R41.3`	Other amnesia	Cognitive testing abnormalities such as amnesia may prompt imaging to evaluate for neurodegenerative causes including amyloid deposition.
`R41.81`	Age-related cognitive decline	Used when documenting cognitive decline to support imaging decisions in the appropriate clinical context.
`F03.90`	Unspecified dementia without behavioral disturbance	When dementia is present but unspecified, amyloid PET may be ordered to identify Alzheimer-associated amyloid deposition.
`G31.9`	Degenerative disease of nervous system, unspecified	Broad code used in complex diagnostic workups where amyloid imaging contributes to characterization of neurodegenerative disease.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`78811`	Radiopharmaceutical localization of tumor imaging; single-day image acquisition, tomographic (SPECT/CT or PET/CT)	Common PET imaging procedure code used for brain PET studies when facilities bill for the imaging service; may be used to capture technical imaging in conjunction with flutemetamol administration.
`78812`	Radiopharmaceutical localization of tumor imaging; multiple-day image acquisition, tomographic	Used in rare protocols requiring multi-day imaging; generally not typical for a single-dose flutemetamol study.
`78813`	Radiopharmaceutical localization of tumor imaging; tomographic, single day, multiple areas, or whole body	Applicable when combined head/neck/whole-body PET protocols are performed, though standard amyloid imaging is brain-only.
`78814`	Bone/brain imaging, additional codes for multiple studies or extensive imaging	May be used when reporting additional complex acquisition sequences beyond a standard brain PET protocol.
`G0219`	Radiopharmaceutical injection and imaging supervision; radiopharmaceutical agent administration	Sometimes used by payers to identify radiopharmaceutical administration and supervision for PET studies; relationship varies by payer policy.

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