CurrentBlue KCPolicy POL-PP-254

Contrast Inclusive to Imaging Services

Defines which contrast agents, radiopharmaceuticals, isotopes and related HCPCS codes are considered inclusive (not separately reimbursable) to facility radiology/cardiology imaging services for specified places of service and applies to facility inpatient and outpatient claims.

Policy Summary

PayerBlue KC

PolicyContrast Inclusive to Imaging Services

Policy CodePolicy POL-PP-254

Change TypeNo material change

Effective DateApr 1, 2025

Next Review DateApr 1, 2027

Key ActionDo not bill the listed HCPCS contrast and radiopharmaceutical codes separately when they are provided with the facility radiology/cardiology imaging service at the indicated places of service.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~60HCPCS codes listed as inclusive

POS 11,19,22,23,49Places of service where policy applies

Facility inpatient/outpatientSettings covered

Professional & FacilityProvider impact

Inclusive Coding Stance

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Inclusive coding stance

The HCPCS codes listed are considered inclusive to the reimbursement for the radiology/cardiology imaging service performed and therefore not separately reimbursable when billed with the imaging service in the indicated facility places of service.

ALL of the following

Places of service (POS)
- POS 11 — Office
- POS 19 — Off-Campus Outpatient Hospital
- POS 22 — On Campus-Outpatient Hospital
- POS 23 — Emergency Room - Hospital
- POS 49 — Independent Clinic
Settings: facility inpatient and facility outpatient claims

Stated policy: The HCPCS codes listed in the coding section are considered inclusive to the reimbursement for the radiology/cardiology imaging service performed and are not separately reimbursable when billed with the imaging service in the indicated places of service.

Contrast and Radiopharmaceutical HCPCS Codes

Contrast and radiopharmaceutical HCPCS codesHCPCSCovered

A9515	Choline C-11, diagnostic, per study dose up to 20 millicuries
A9526	Nitrogen N-13 ammonia, diagnostic, per study dose, up to 40 millicuries
A9552	Fluorodeoxyglucose F-18 FDG, diagnostic, per study dose, up to 45 millicuries
A9555	Rubidium Rb-82, diagnostic, per study dose, up to 60 millicuries
A9573	Injection, gadopiclenol, 1 ml
A9575	Injection, gadoterate meglumine, 0.1 ml
A9576	Injection, gadoteridol, (ProHance multipack), per ml
A9577	Injection, gadobenate dimeglumine (multihance), per ml
A9578	Injection, gadobenate dimeglumine (multihance multipack), per ml
A9579	Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified

1–10 of 50

1/5

Coverage & Adjudication Notes

Billing Rule

Coverage & adjudication note — provider action

Coverage of any service is determined by date of service, the member's eligibility and benefit limits for the service(s) rendered, all terms of the Provider Service Agreement, and applicable coding rules and billing/adjudication guidance. Final payment is subject to claims adjudication edits and industry-standard payment methodologies. If there is any conflict between a Provider Payment Policy and a member's coverage document, the member's coverage document governs. For confirmation of coverage or medical necessity determinations, contact the appropriate Blue KC Provider Hotline.

Coverage determined by date of service and member eligibility/benefit limits
Subject to Provider Service Agreement terms and applicable coding/billing rules
Final payment subject to claims adjudication and standard edits
If conflict exists, member's coverage document governs
Contact Blue KC Provider Hotlines for coverage/medical necessity confirmation: Commercial 816-395-3929; ACA 866-859-3822; Medicare Advantage 866-508-7140

Places of Service Definitions

Office — POS 11

Place of Service (POS) code11

TermOffice

DefinitionLocation, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis.

Off-Campus Outpatient Hospital — POS 19

Place of Service (POS) code19

TermOff-Campus Outpatient Hospital

DefinitionA portion of an off-campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.

On Campus-Outpatient Hospital — POS 22

Place of Service (POS) code22

TermOn Campus-Outpatient Hospital

DefinitionA portion of a hospital's main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.

Emergency Room - Hospital — POS 23

Place of Service (POS) code23

TermEmergency Room - Hospital

DefinitionA portion of a hospital where emergency diagnosis and treatment of illness or injury is provided.

Independent Clinic — POS 49

Place of Service (POS) code49

TermIndependent Clinic

DefinitionA location, not part of a hospital and not described by any other Place of Service code, that is organized and operated to provide preventive, diagnostic, therapeutic, rehabilitative, or palliative services to outpatients only.