Summary & Overview
HCPCS Q9965: Low Osmolar Contrast, 100–199 mg/ml, per ml
HCPCS Level II code Q9965 designates low osmolar iodinated contrast material with an iodine concentration of 100–199 mg/ml, billed per milliliter. This code is relevant nationwide for hospitals, outpatient imaging centers, and clinics that perform contrast-enhanced CT scans, angiography, and interventional fluoroscopic procedures. Accurate use of Q9965 supports proper supply billing and inventory tracking for commonly used intravascular contrast agents.
Key payers included in this review are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for using low osmolar contrast at this concentration range, typical sites of service, and which services generate supply-line billing. The publication summarizes common modifiers and billing considerations when contrast is billed per milliliter and outlines where data was available versus where input fields were not provided.
The report offers operational benchmarks and coding guidance details, highlights payer coverage patterns and reimbursement considerations at a national level, and clarifies documentation elements that support billing for contrast material by volume. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code Q9965 represents low osmolar contrast material with an iodine concentration of 100–199 mg/ml, billed per ml. This product is used as an intravascular contrast agent for diagnostic imaging procedures that require iodinated contrast to enhance visualization of vascular structures and organ parenchyma.
Service Type: Radiology contrast agent administration (intravascular diagnostic imaging)
Typical Site of Service: Hospital outpatient departments, hospital inpatient settings, outpatient imaging centers, and clinics where contrast-enhanced CT, angiography, or fluoroscopic studies are performed.
Clinical & Coding Specifications
Clinical Context
A 62-year-old outpatient presents to the radiology suite for a contrast-enhanced computed tomography (CT) of the abdomen and pelvis to evaluate new-onset abdominal pain and suspected hepatic lesion seen on prior ultrasound. The ordering physician documents clinical indications including focal liver lesion, elevated liver enzymes, and prior nondiagnostic ultrasound. The patient has an intravenous access established by the radiology nurse. A low osmolar iodinated contrast agent with iodine concentration between 100–199 mg/mL is selected and administered intravenously according to the CT protocol for multiphase liver imaging. The technologist records the volume of contrast used in milliliters for supply tracking and billing. The radiologist performs image acquisition, interprets the study, and documents findings and contrast administration details in the report. Typical site of service is an outpatient radiology department or hospital outpatient imaging center; it can also be used in inpatient CT services when clinically indicated. Patient monitoring for allergic reaction or contrast extravasation occurs during and after injection; emergency medications and protocols are available in the imaging suite.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management (E/M) service by the same physician on the day of a procedure | Use when a same-day E/M visit warrants separate payment in addition to the imaging service that used contrast. |