HCPCS Code A9500: Technetium tc-99m Sestamibi, Diagnostic, Per Study Dose

Learn about the HCPCS code A9500 for "Technetium tc-99m sestamibi, diagnostic, per study dose" through this guide.

## **What is the HCPCS code A9500 for?** The HCPCS code A9500 is under the category Diagnostic and Therapeutic Pharmaceuticals. This code designates the provision of technetium tc-99m sestamibi, a radiopharmaceutical (diagnostic agent). It is administered to the patient before conducting imaging studies, and it's done so intravenously. It travels to organs like the heart and parathyroid gland. Healthcare professionals then use special camera equipment so they can capture certain details that help them make the necessary analyses and interpretations to make informed diagnoses. Common applications include cardiac stress tests myocardial perfusion scans, breast imaging, parathyroid imaging, etc.

## **Documentation requirements for A9500** As with any HCPCS code, it's important for you to have sufficient documentation that meets the correct coding guidelines and requirements set by your insurer, especially policy articles and local coverage determinations relative to your insurer and your practice. Here are examples of what you need: - The full name of the patient - The full names and credentials of the healthcare professionals providing patient care and conducting tests - The name, address, and type of facility where this substance was administered - The relevant information and indications related to your patient's medical record and current condition (e.g., suspected coronary artery disease, evaluation of ischemia, oncologic imaging, etc.) - Types of imaging procedures conducted (e.g., stress/rest myocardial perfusion) - Dosage and administration details (millicuries per dose, single or multiple doses, if applicable) - Radiopharmaceutical lot number and manufacturer (per compliance requirements)

## **Billing requirements for A9500** Besides the documentation requirements above, please make sure to take note of or have the following as well before filing for reimbursement: - 1 study dose = 1 unit - Do not bill separately for each injection if both rest and stress phases are performed in the same study - This is billed separately from the imaging test(s) conducted - Speaking of imaging tests, please use the applicable CPT code for the tests conducted - Use the necessary ICD codes applicable to your patient's condition - This is generally covered by Medicare so long as medical necessity is justified for diagnostic imaging

## **Other similar codes** - **A9502** - Technetium tc-99m tetrofosmin, diagnostic, per study dose - **A9501** - Technetium tc-99m teboroxime, diagnostic, per study dose - **A9521** - Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries - **A9539** - Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries - **A9562** - Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries

Frequently asked questions

Most commonly used for myocardial perfusion imaging (MPI) to evaluate coronary artery disease.

Yes. A9500 covers the radiopharmaceutical supply, while CPT 78452 covers the imaging procedure. Both are typically billed together.

Risks include reactions at the injection sites and allergic reactions to the radiotracer. It's also possible for the patient to suffer radiation exposure. Please monitor your patients closely.