CurrentUnitedHealthcarePolicy 2026R0104C

Contrast and Radiopharmaceutical Materials Reimbursement

Defines UnitedHealthcare's reimbursement rules for high/low osmolar contrast and radiopharmaceutical materials billed on CMS-1500 (and equivalents) for Commercial and Individual Exchange plans; applies to physicians and other qualified health care professionals.

Policy Summary

PayerUnitedHealthcare

PolicyContrast and Radiopharmaceutical Materials Reimbursement

Policy CodePolicy 2026R0104C

Change TypeASCFS code table and eligible procedure list updatesminor verbiage clarification

Effective Date

Next Review Date

Key ActionDo not bill HCPCS contrast/radiopharmaceutical materials with a facility place of service for physician reimbursement; bill separately in non-facility settings when eligible.

SourceLink

POLICY UPDATE CHANGES

Policy Table Update: ASCFS Contrast and Radiopharmaceutical Materials Codes.

Policy List Change: ASCFS Eligible Imaging and Therapeutic Procedures Code List.

Verbiage update to reflect 'Qualified' Health Care Professional.

CMS-1500Form to which this policy applies

ASC POS 24ASC technical/materials may be separately reimbursable

Non-facility POSSeparate reimbursement allowed for materials

Up to 2 daysMaterials allowed prior to nuclear medicine scan

Policy Summary

PayerUnitedHealthcare

PolicyContrast and Radiopharmaceutical Materials Reimbursement

Policy CodePolicy 2026R0104C

Change TypeASCFS code table and eligible procedure list updatesminor verbiage clarification

Effective Date

Next Review Date

Key ActionDo not bill HCPCS contrast/radiopharmaceutical materials with a facility place of service for physician reimbursement; bill separately in non-facility settings when eligible.

SourceLink

On This Page

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.

Contrast and Radiopharmaceutical Materials Coverage Criteria

Contrast and Radiopharmaceutical Materials reimbursement criteria

Reimbursement stance for contrast and radiopharmaceutical materials based on place of service and associated procedures:

Services Reported in a CMS Facility Place of Service: No separate reimbursement to a physician or other qualified health care professional for the technical component or global service of an imaging procedure when the procedure is performed in a facility Place of Service (19, 21, 22, 23, 24, 26, 34, 51, 52, 56, or 61). UnitedHealthcare will not provide reimbursement to a physician or other qualified health care professional for High Osmolar Contrast Materials (HOCM), Low Osmolar Contrast Materials (LOCM) or Radiopharmaceutical Materials submitted with HCPCS codes (e.g., A4641, A4642, A9500–A9700, J1245, Q3001, Q9951–Q9968) with a facility POS because these materials are needed to perform the technical component of the imaging or therapeutic nuclear medicine procedure.

ASC exception: Ambulatory Surgical Center (POS 24) exception: Separate reimbursement to a physician for HOCM, LOCM or Radiopharmaceutical Materials will be allowed in an ASC (POS 24) when provided in conjunction with eligible imaging procedures that are NOT included on the CMS Ambulatory Surgical Center Fee Schedule (ASCFS) Addendum BB.

ASCFS listed procedures exclusion: The technical component, global service and associated HOCM, LOCM or Radiopharmaceutical Materials for procedures listed on the ASCFS Addendum BB are included in the facility case rate and are not separately reimbursable.

Service Reported in a CMS Non-Facility Place of Service: 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 HOCM, LOCM or Radiopharmaceutical Materials when reported on the same date of service with a procedure code that requires contrast or Radiopharmaceutical Materials.

Lookback allowance for nuclear medicine: UnitedHealthcare will 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 (limited to CPT codes 78012–79999).

Pairing exclusion for A9512: Per 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.

Procedure eligibility condition: Separate reimbursement for materials is allowed only when the associated imaging/therapeutic or nuclear medicine procedure is eligible for reimbursement (i.e., not denied under another UnitedHealthcare reimbursement policy).

Code Mappings and Timing Rules

ASCFS code mappingsmixed

78267	Mapped ASCFS nuclear medicine codes (examples listed)
A4641	Contrast and radiopharmaceutical materials (table mappings shown)
Q3001	Listed in ASCFS contrast codes

ASCFS Nuclear Medicine Codes (detail)CPT

78268	Mapped from 78267, position 1
78350	Mapped from 78267, position 2
78351	Mapped from 78267, position 3
78609	Mapped from 78267, position 4
78835	Mapped from 78267, position 5

ASCFS Contrast and Radiopharmaceutical Materials Codes (detail)HCPCS

A4642	Mapped from A4641, position 1
A9513	Mapped from A4641, position 2
A9517	Mapped from A4641, position 3
A9521	Mapped from A4641, position 4
A9530	Mapped from A4641, position 5
A9543	Mapped from A4641, position 6
A9563	Mapped from A4641, position 7
A9564	Mapped from A4641, position 8
A9568	Mapped from A4641, position 9
A9589	Mapped from A4641, position 10

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Lookback window for radiopharmaceutical materials (inv-03)

Lookback windowRadiopharmaceutical materials may be reported with a date of service up to 2 days prior to a nuclear medicine imaging scan (CPT 78012-79999).

Applicable procedure rangeApplies specifically to nuclear medicine imaging scans (CPT codes 78012-79999).

LimitationThe 2-day prior allowance applies only to nuclear medicine imaging scans, not to all eligible imaging or therapeutic procedures.

Billing and Provider Action Requirements

Billing Rule

Do not bill HCPCS materials with facility POS; follow separate reimbursement rules

Do not bill HCPCS contrast or radiopharmaceutical materials with a facility place of service for physician reimbursement. Separate reimbursement is allowed in non-facility settings and in Ambulatory Surgical Center (POS 24) only for eligible procedures; materials associated with procedures listed on the CMS ASCFS Addendum BB are included in the facility case rate and are not separately reimbursable. Also, per CMS coding guidelines, A9512 will not be separately reimbursed when submitted with A9538 or A9560 on the same day by the same group.

No reimbursement to a physician or other qualified health care professional for HOCM, LOCM, or Radiopharmaceutical Materials submitted with HCPCS codes when the procedure is performed in a facility POS because materials are needed for the technical component.
Separate reimbursement allowed in ASC (POS 24) only when provided with eligible imaging procedures not included on CMS ASCFS Addendum BB; procedures on Addendum BB have materials included in facility case rate and are not separately reimbursable.
When performed in a non-facility setting, separate reimbursement allowed to the Same Group Physician/Other Qualified Health Care Professional when billed same date as a procedure that requires contrast or radiopharmaceuticals; radiopharmaceuticals may also be reimbursed up to two days prior to a nuclear medicine imaging scan.

Key Definitions

Osmolar Contrast Materials (inv-05)

DefinitionAn iodine-based substance administered intravascularly, intra-articularly or intrathecally 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.

Administration routesIntravascular, intra-articular, intrathecal.

PurposeEnhance visibility during imaging or interventional procedures (with contrast or imaging guidance).

Radiopharmaceutical Materials (inv-06)

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

Use caseUsed as diagnostic or therapeutic agents in nuclear medicine imaging and related procedures.