Summary & Overview
HCPCS Q9957: Injection, Perflutren Lipid Microspheres, per ml
HCPCS Level II code Q9957 denotes an injectable formulation of perflutren lipid microspheres billed per milliliter for use as an ultrasound contrast agent. It is nationally relevant because contrast-enhanced ultrasound can improve diagnostic accuracy for a range of vascular and organ imaging indications, and coding clarity affects coverage, billing consistency, and cross-payer comparability. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what the code represents, typical clinical and site-of-service contexts for use, and which major payers cover this supply-based imaging agent. The publication provides benchmarking and policy context where available, highlights common billing practices for injectable contrast supplies, and summarizes payer coverage patterns and billing considerations. Data not available in the input where payer-specific rates, modifier usage trends, or associated diagnosis coding would normally be detailed.
Billing Code Overview
HCPCS Level II code Q9957 describes Injection, perflutren lipid microspheres, per ml. This code represents a contrast agent supplied as an injectable suspension of perflutren lipid microspheres used to enhance ultrasound imaging. Service type: contrast ultrasound agent administration. Typical site of service: imaging facilities, hospital outpatient departments, and ambulatory care centers where diagnostic ultrasound studies requiring contrast enhancement are performed.
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Clinical & Coding Specifications
Clinical Context
A 68-year-old male with a history of ischemic heart disease and chronic shortness of breath is referred for a transthoracic echocardiogram with contrast to better define left ventricular endocardial borders and assess wall motion during an outpatient cardiology visit. The patient arrives at the outpatient imaging center; nursing documents allergies and IV access is established. Perflutren lipid microspheres (Q9957) are prepared by pharmacy or trained technicians and drawn into a syringe per manufacturer dosing guidance. The sonographer performs baseline two-dimensional and Doppler imaging, then injects the contrast agent intravenously while acquiring contrast-enhanced images to delineate endocardial borders, evaluate ejection fraction, and assess for regional wall motion abnormalities. The study is interpreted by a cardiologist. Typical documentation includes indication, amount of Q9957 administered (ml), IV site, any immediate adverse reaction, imaging findings, and the cardiologist’s interpretation. Typical site of service is an outpatient hospital-based or freestanding echocardiography/imaging center; the service type is an ultrasound contrast agent injection used as an adjunct to diagnostic echocardiography.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |