CurrentColorado Rocky Mountain Health PlansPolicy 2026R0104C

Reimbursement for contrast and radiopharmaceutical materials

Governs when UnitedHealthcare will reimburse physicians and other qualified health care professionals for high/low osmolar contrast materials and radiopharmaceutical materials for services billed on CMS-1500 (and electronic equivalent), across Commercial and Individual Exchange plans (not Oxford).

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyReimbursement for contrast and radiopharmaceutical materials

Policy CodePolicy 2026R0104C

Change TypeCode list and table updates (Apr 26, 2026Jan 1, 2026)

Effective Date

Next Review Date

Key ActionAllow separate reimbursement to Same Group Physician or Other Qualified Health Care Professional for contrast and radiopharmaceutical materials when procedure performed in non-facility POS and when reported with a procedure code that requires contrast or radiopharmaceutical materials.

SourceLink

POLICY UPDATE CHANGES

Policy Table Change: ASCFS Contrast and Radiopharmaceutical Materials Codes and ASCFS Eligible Imaging and Therapeutic Procedures Code List were updated on 4/26/2026.

Policy List Change: Contrast and Radiopharmaceutical Materials Code and Eligible Imaging and Therapeutic Procedures Code List updated on 1/1/2026.

CMS-1500claim form applicability

separate allowedphysician reimbursement stance

no separatefacility POS restriction

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.

Separate Reimbursement Criteria

Covered when ALL of the following are met:

ALL of the following

Service billed on CMS-1500 (or electronic equivalent)
Associated imaging, therapeutic, or nuclear medicine procedure is eligible for reimbursement (not denied under other UnitedHealthcare policies)
Eligibility determined by applicable reimbursement policies and the Eligible Imaging and Therapeutic Procedures Code List
Place of service
- Procedure performed in a non-facility Place of Service (separate reimbursement allowed to the Same Group Physician or Other Qualified Health Care Professional)
- Exception: Ambulatory Surgical Center (ASC) POS 24 — separate reimbursement allowed when provided with eligible imaging procedures that are NOT listed on the CMS ASCFS Addendum BB
Contrast or radiopharmaceutical materials are reported on the same date of service with the procedure code that requires contrast or radiopharmaceutical materials
For nuclear medicine imaging scans, materials may be reported up to two days prior to the scan
Do not reimburse HCPCS A9512 when submitted the same day with A9538 or A9560 by the Same Group Physician or Other Qualified Health Care Professional

Codes and Timing Details

Contrast and Radiopharmaceutical Materials (example codes)HCPCS

A4641-A4642, A9500-A9700, J1245, Q3001, Q9951-Q9968

Contrast and radiopharmaceutical material HCPCS codes referenced as not reimbursable in facility POS and listed for ASCFS mapping

ASCFS Nuclear Medicine CodesCPT

78267-78835 (selected)

ASCFS nuclear medicine procedure codes listed for ASC mappings

inv-04: prior-day allowance for radiopharmaceuticals — up to 2 days prior for nuclear medicine imaging scans

Prior-day allowance for radiopharmaceuticalsSeparate reimbursement allowed for radiopharmaceutical materials reported up to 2 days prior to a nuclear medicine imaging scan.

Same-date reportingSeparate reimbursement permitted when contrast or radiopharmaceuticals are reported on the same date of service with a procedure code that requires them.

A9512 coding restrictionDo not provide separate reimbursement for HCPCS A9512 when submitted the same day with A9538 or A9560 by the Same Group Physician or Other Qualified Health Care Professional.

Reimbursement Conditions and Provider Billing Guidance

Billing Rule

Reimbursement conditions and timing for contrast and radiopharmaceutical materials

When an imaging or therapeutic nuclear medicine procedure is performed in a non-facility setting, UnitedHealthcare will provide separate reimbursement to the Same Group Physician or Other Qualified Health Care Professional for high or low osmolar contrast materials (HOCM/LOCM) or radiopharmaceutical materials when reported on the same date of service with a procedure code that requires those materials. UnitedHealthcare will also allow separate reimbursement for contrast and radiopharmaceutical materials reported with a date of service up to two days prior to a nuclear medicine imaging scan. In accordance with CMS coding guidelines, UnitedHealthcare will not provide separate reimbursement for Radiopharmaceutical Materials HCPCS code A9512 when submitted with A9538 or A9560 on the same day by the Same Group Physician or Other Qualified Health Care Professional.

Separate reimbursement allowed only in non-facility place of service when billed with a procedure code that requires contrast or radiopharmaceutical materials.
Materials may be reported up to 2 days prior to the nuclear medicine imaging scan for radiopharmaceuticals.
Do not reimburse A9512 when submitted the same day with A9538 or A9560 by the same group.

Key Terms

inv-06: Osmolar Contrast Materials — An iodine-based substance administered intravascularly, intra-articularly or intrathecally used to enhance imaging visibility.

DefinitionAn iodine-based substance administered intravascularly, intra-articularly or intrathecally used to enhance the visibility of structures or fluids within the body during an imaging procedure (e.g., X-ray, MRI, CT) or other diagnostic/interventional cardiovascular procedures.

PurposeUsed to improve imaging contrast so anatomical structures and fluids are more visible during diagnostic and interventional procedures.

Administration routesIntravascular, intra-articular, or intrathecal.

inv-07: Radiopharmaceutical Materials — Radioactive chemical or pharmaceutical preparations used as diagnostic or therapeutic agents.

DefinitionRadioactive chemical or pharmaceutical preparations used as diagnostic or therapeutic agents.