Q9964 High Osmolar Contrast HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS Level II Q9964: High Osmolar Contrast Material, >=400 mg/ml

HCPCS Level II code Q9964 designates high osmolar iodinated contrast material with an iodine concentration of 400 mg/ml or greater, billed per milliliter. This code matters nationally because contrast agents are integral to a wide range of diagnostic and interventional imaging procedures; accurate coding affects clinical documentation, inventory tracking, and payer reimbursement workflows across hospitals and imaging centers. 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 use and billing context for Q9964, plus what to expect from benchmarks and policy coverage considerations at a national level. The publication outlines typical sites of service and clinical scenarios where high-iodine concentration contrast is used, summarizes common modifiers and billing practices when available, and highlights areas where payers often establish coverage rules or prior authorization requirements. If specific payer policies or local coverage determinations are not provided, the reader will see noted where data is unavailable. The brief also points to related coding considerations for radiology supply management and procedure-level billing.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareQ9964HCPCS Level IIcontrast agentradiologyimaging suppliesinterventional radiologydiagnostic imaginghigh osmolar contrast

Billing Code Overview

HCPCS Level II code Q9964 represents high osmolar contrast material with an iodine concentration of 400 mg/ml or greater, billed per milliliter. This product is used as an intravascular contrast agent to enhance imaging quality during radiologic procedures that require high iodine concentration for vascular or soft-tissue visualization.

Service type: Contrast agent for diagnostic and interventional radiology

Typical site of service: Hospital outpatient radiology suites, inpatient radiology departments, and interventional radiology settings

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A patient presenting for an iodinated contrast–enhanced imaging study receives high osmolar contrast material (Q9964, high osmolar contrast material, ≥400 mg/mL iodine concentration, per mL) when the clinical team determines a high-iodine concentration agent is required or when formulary/availability necessitates its use. Typical settings include the radiology department, the CT suite, the angiography/interventional radiology (IR) suite, or the emergency department when rapid vascular opacification is needed for diagnostic CT angiography, peripheral angiography, or certain fluoroscopic angiographic studies. The typical patient is an adult requiring high-contrast density for visualization of vascular structures or lesions — for example, an adult with suspected pulmonary embolism undergoing CT pulmonary angiography, a patient scheduled for peripheral arterial angiography for critical limb ischemia, or a patient in the emergency department needing rapid vascular assessment.

Workflow: The ordering clinician documents the indication and relevant ICD-10 diagnosis on the imaging order. A registered nurse or radiology technologist screens the patient for contrast allergies, renal function (serum creatinine/eGFR), and medication interactions. Informed consent for contrast administration is obtained when indicated. The pharmacy or imaging supply system dispenses Q9964 and the radiology team logs the amount used in milliliters. The administering provider documents the contrast agent, volume, lot number, and any immediate adverse reactions. Post-procedure monitoring occurs per institutional protocol, particularly for patients with renal impairment or prior allergic reactions.

Coding Specifications

Modifier	Description

HCPCS Level II Q4363: Amnio Membrane Application, Per Square Centimeter

HCPCS-Q4158-KERECIS-OMEGA3-BIOLOGIC-GRAFT-WOUND-CARE

HCPCS Q4158: Kerecis Omega3 Biologic Graft, Per sq cm

HCPCS-Q4198-GENESIS-AMNIOTIC-MEMBRANE-PER-SQ-CM

HCPCS Q4198: Genesis Amniotic Membrane, Per Square Centimeter

HCPCS-Q0512-PHARMACY-SUPPLY-FEE-ORAL-ANTICANCER-IMMUNOSUPPRESSIVE

HCPCS Q0512: Pharmacy Supply Fee for Subsequent 30-Day Oral Therapy

HCPCS-Q4329-SINGLAY-PER-SQ-CM-ADD-ON-SUPPLY

HCPCS Q4329: Singlay Supply, Per Square Centimeter (Add-on)

HCPCS-Q4273-ESANO-AAA-PER-SQUARE-CENTIMETER-ADD-ON

HCPCS Q4273: Esano aaa, per square centimeter (Add-on)

HCPCS-Q4220-BELLACELL-SUREDERM-DERMAL-PRODUCT-PER-SQ-CM-ADDON

HCPCS Level II Q4220: Bellacell hd or Surederm, Per Square Centimeter

HCPCS-Q4378-RENEW-FT-MATRIX-PER-SQ-CM

HCPCS Q4378: Renew FT Matrix, Per Square Centimeter

HCPCS-Q4344-TRI-MEMBRANE-WRAP-ADD-ON-PER-CM

HCPCS Q4344: Tri-membrane Wrap, Per Square Centimeter

HCPCS-Q0501-VAD-SHOWER-COVER-REPLACEMENT

HCPCS Q0501: Shower Cover for Ventricular Assist Device, Replacement Only

Showing 1–10 of 629

`00`	No modifier — standard service	Use when no circumstances require a modifier for the contrast administration line item.
`22`	Increased procedural services	Use when administration required substantially greater work than usual (rare for contrast but may apply when documented complexity in preparation/administration exists).
`23`	Unusual anesthesia	Use when medically necessary anesthesia unrelated to contrast would be reported for the associated imaging procedure (contrast line remains unmodified unless payer requires).
`52`	Reduced services	Use when less than the full contrast volume or reduced service is provided and documentation supports reduction.
`53`	Discontinued procedure	Use when contrast administration or the imaging study was started but discontinued for documented clinical reasons prior to completion.
`54`	Surgical care only	Not typically used on contrast supply lines; applicable to associated surgical/procedural codes when physician provides only part of global period care.
`55`	Postoperative management only	Not typically used for contrast billing; included when separate postoperative care applies to the provider billing other services.
`62`	Two surgeons	Use when two surgeons are involved in an associated surgical procedure requiring separate claims; generally not applicable to contrast supply but available if payer requires surgeon-level modifiers on related procedure lines.
`80`	Assistant surgeon	Use when an assistant surgeon is involved in the main procedure; rarely applied to contrast supply lines but relevant to associated operative billing.
`82`	Assistant surgeon when qualified resident not available	Use when an assistant surgeon is required and no qualified resident present; relates to associated procedural claims.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist service	Use when a PA/NP/CNS performs or assists in administration under applicable payer rules and the payer requires reporting of non-physician performer on the claim.
`CO`	Genetic testing — physician or qualified health care professional completed test order	Rarely applied to contrast; included in provided list but seldom used for imaging contrast billing.
`QX`	CRNA service: medical direction by physician	Use when a certified registered nurse anesthetist provides anesthesia under physician direction for the associated procedure.
`QY`	Medical direction of one CRNA by a physician	Use when physician directs a CRNA for anesthesia associated with the imaging/procedure.

Taxonomy Code	Specialty	Notes
`2085P0800X`	Diagnostic Radiology	Primary specialty ordering and administering contrast for CT and angiographic imaging.
`2086P0202X`	Interventional Radiology	Performs angiography, vascular interventions, and contrast-dependent procedures.
`2084P0800X`	Neuroradiology	Uses high-concentration contrast for neurovascular diagnostic and interventional studies.
`208D00000X`	Emergency Medicine	Orders emergent contrast-enhanced imaging in acute settings.
`363L00000X`	Vascular Surgery	Requests and performs contrast-dependent peripheral angiography and interventions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I26.99`	Other pulmonary embolism without acute cor pulmonale	Pulmonary embolism evaluation often uses CT pulmonary angiography with high-concentration iodinated contrast for arterial opacification.
`I82.401`	Acute embolism and thrombosis of unspecified deep veins of right lower extremity	Peripheral venous/arterial studies and diagnostic angiography may utilize concentrated contrast during intervention or diagnostic imaging.
`I70.219`	Atherosclerosis of native arteries of the extremities, unspecified extremity with rest pain	Peripheral arterial disease assessment and angiography commonly use high-iodine contrast for lesion visualization.
`I71.3`	Abdominal aortic aneurysm, ruptured	CT angiography for suspected ruptured AAA requires high contrast concentration to delineate vascular injury.
`K55.9`	Vascular disorder of intestine, unspecified	Mesenteric ischemia workup with CT angiography uses high-iodine concentration contrast for arterial phase imaging.
`G45.9`	Transient cerebral ischemic attack, unspecified	Neurovascular CTA performed for TIA/stroke evaluation frequently uses concentrated contrast for vessel imaging.
`N17.9`	Acute kidney failure, unspecified	Important comorbidity to document and consider when administering high-osmolar contrast due to nephrotoxicity risk.
`Z88.0`	Allergy status to penicillin (example of documented allergy)	Documented history of prior contrast reaction or other allergies is clinically relevant for screening and prophylaxis before administering high-osmolar contrast.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`71260`	CT angiography, chest, with contrast, including noncontrast and contrast-enhanced phases when performed; with contrast material(s)	Frequently performed with high-iodine concentration contrast agents for CT pulmonary angiography to evaluate pulmonary embolism or vascular anatomy.
`74174`	CT angiography, abdomen and pelvis; with contrast, including noncontrast and contrast-enhanced phases when performed	Used for evaluation of abdominal aortic aneurysm, mesenteric ischemia, or other vascular pathology often requiring high-concentration contrast for arterial phase imaging.
`75635`	Angiography, lower extremity, bilateral, including catheter placement, radiological supervision and interpretation	Peripheral arterial angiography commonly uses concentrated iodinated contrast agents during interventional radiology procedures.
`75726`	Angiography, selective, extremity, unilateral, radiological supervision and interpretation	Selective angiography of an extremity vessel where concentrated contrast is injected to opacify small-caliber arteries.
`74160`	Radiologic examination, abdomen; contrast enhanced CT, without contrast material, followed by contrast material(s) and further sections	Common CT workflow code paired with high-iodine contrast for multiphase abdominal imaging.
`70498`	CT angiography, head/neck or other advanced CTA not otherwise specified	Neurovascular CTA often requires high-concentration contrast for optimal vessel opacification.

OpenPayer