Summary & Overview
HCPCS Level II C9060: Fluoroestradiol F18 Diagnostic PET Radiopharmaceutical
HCPCS Level II code C9060 represents fluoroestradiol F18, diagnostic, 1 mCi — a PET radiopharmaceutical used to image estrogen receptor activity. This code identifies a specific diagnostic agent that can inform clinical decisions in oncology, particularly for assessing receptor status noninvasively. Nationally, precise coding for radiopharmaceuticals matters for clinical workflow, billing consistency, and coverage determinations as PET imaging use expands.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for C9060, typical sites of service, and which payers are relevant for coverage considerations. The publication summarizes benchmarks and policy-related topics readers should watch, including coverage criteria, prior authorization trends, and utilization patterns where available. It also provides coding context to help billing teams and radiology departments align documentation and claim submission with payer expectations.
Data not provided in the input (such as associated taxonomies, ICD-10 diagnoses, detailed payer-specific policy language, or related codes) is noted as unavailable. The content focuses on national implications and operational considerations for incorporating HCPCS Level II code C9060 into diagnostic PET workflows.
Billing Code Overview
HCPCS Level II code C9060 is for fluoroestradiol F18, diagnostic, 1 mCi, a radiopharmaceutical used in diagnostic PET imaging. The service involves administration of the radiotracer and acquisition of diagnostic PET images to evaluate biologic processes related to estrogen receptor expression.
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Service type: Diagnostic PET radiopharmaceutical administration and imaging
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Typical site of service: Outpatient imaging centers and hospital outpatient departments
Clinical & Coding Specifications
Clinical Context
A 62-year-old woman with a history of breast cancer and new focal bone pain is referred for a PET diagnostic study using Fluoroestradiol F18 (FES-FDG) to evaluate estrogen receptor (ER) expression in metastatic lesions. The imaging study is ordered by a medical oncologist to determine ER status of recurrent or metastatic disease when biopsy is infeasible or yields indeterminate receptor status. The typical clinical workflow: the patient arrives fasting per nuclear medicine protocol, pre-procedure screening and pregnancy testing as indicated, IV access is established, and a radiopharmacist/specialty pharmacy dispenses 1 mCi of Fluoroestradiol F18 (billing code C9060). The nuclear medicine technologist administers the tracer, observes an uptake/uptake period per protocol, and performs PET/CT imaging. Images are reconstructed and interpreted by a nuclear medicine physician or radiologist with an oncology consult to integrate results into treatment planning. Typical site of service is an outpatient imaging center, hospital outpatient department, or ambulatory surgical center with licensed PET radiopharmacy capability. A typical patient scenario includes those with suspected metastatic breast cancer, equivocal conventional imaging findings, or when ER-targeted therapy selection depends on functional receptor imaging.
Coding Specifications
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