Summary & Overview
HCPCS C9461: Choline C 11 Diagnostic PET Study Dose
HCPCS Level II code C9461 denotes the diagnostic radiopharmaceutical Choline C 11, billed per study dose for PET imaging. This agent is used in PET diagnostic studies to evaluate biochemical processes in tissues, frequently in oncologic imaging where choline uptake can indicate malignancy. Nationally, accurate coding for radiopharmaceuticals like C9461 matters for consistent clinical documentation, reimbursement, and utilization tracking of advanced imaging agents.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for Choline C 11, typical sites where the service is delivered, and what to expect in payer coverage considerations. The publication lays out benchmarking and policy-relevant items such as common billing practices for per-study dosing, variations in payer coverage policies, and implications for facility-level revenue cycle processes.
The analysis equips clinical managers, coding specialists, and policy analysts with: a clear definition of the code and service type; expected places of service for PET radiopharmaceutical studies; summary points on payer coverage patterns; and pointers on where to look for payer-specific policy updates and reimbursement guidance. Data not available in the input is identified explicitly where relevant.
Billing Code Overview
HCPCS Level II code C9461 describes Choline C 11, diagnostic, per study dose. This code represents a radiopharmaceutical diagnostic agent used in nuclear medicine imaging studies involving positron emission tomography (PET) with choline labeled with carbon-11.
Service Type: Diagnostic radiopharmaceutical administration for PET imaging
Typical Site of Service: Hospital outpatient imaging departments, ambulatory imaging centers, and specialty nuclear medicine facilities
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with a history of prostate cancer and rising prostate-specific antigen (PSA) after definitive local therapy is referred for a PET diagnostic imaging study using C9461 (Choline C 11, diagnostic, per study dose). The clinical workflow begins with order entry by the oncologist specifying PET imaging for biochemical recurrence. Scheduling staff confirm patient eligibility and fasting instructions. On the day of service the nuclear medicine technologist verifies identity, reviews medication and allergy history, explains the procedure, and administers the radiotracer C9461 intravenously. After an uptake period, the patient undergoes PET/CT imaging in the nuclear medicine suite; images are reconstructed and reviewed by a nuclear medicine physician or radiologist. The interpreting physician documents findings, correlates PET uptake with CT anatomic detail to localize recurrent or metastatic disease, and generates a report for the referring clinician. Billing is submitted using C9461 per study dose for the radiopharmaceutical, with the imaging CPT and facility codes billed separately as applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |