## **What is HCPCS code A9552?**
HCPCS code A9552, maintained by the Centers for Medicare and Medicaid Services (CMS), identifies the supply of the radiopharmaceutical Fluorodeoxyglucose F-18 FDG, which is the tracer used in a standard FDG-PET scan or FDG-PET/CT scan. This agent, a radioactive form of glucose, is utilized across various medical specialties—most frequently in oncology for cancer staging, restaging, and monitoring therapy response—but also for certain cardiac and neurologic conditions to assess tissue metabolic function.
Because it represents the drug/supply cost, A9552 is typically billed by the facility performing the imaging (the technical component provider), and it must be reported on the same date of service as the primary PET CPT code (like 78815 or 78816).
## **Documentation requirements**
When billing A9552, providers must include relevant details about clinical management:
### **Medical necessity**
The record must clearly justify the need for diagnostic tests, particularly the PET scan, including the rationale for choosing a positron emission tomography (PET) scan over other imaging modalities.
### **Order and indication**
A legible order from the treating physician must be present, along with the specific oncologic, neurologic, or cardiac condition being investigated, and the clinical question the scan is intended to answer (e.g., initial staging, restaging, evaluation of tumor recurrence, or therapy response).
### **Radiopharmaceutical information**
- **Agent used**: Clearly state the use of Fluorodeoxyglucose F-18 (FDG).
- **Dosage**: Document the total dose administered (in millicuries or mCi), ensuring it is within the coded limit (up to 45 millicuries).
- **Acquisition cost**: The actual acquisition/invoice cost of the radiopharmaceutical must be documented internally, as it's required for billing.
### **Procedure report**
The official PET scan report must be included, detailing the technical components, comparison with prior studies, and interpretation.
## **Billing requirements**
Billing for A9552 follows the following specific rules, especially when paired with the PET procedure code.
- **Billed by facility**: A9552 is generally a supply code that represents the cost of the FDG tracer and is typically billed by the facility (e.g., hospital outpatient department or freestanding imaging center) providing the technical component of the PET scan.
- **Paired with PET procedure code**: A9552 must be billed on the same date of service as the corresponding PET procedure code (e.g., CPT codes 78811–78816 for oncologic PET/PET-CT).
- **Payment**: Medicare and many payers generally pay for diagnostic radiopharmaceuticals based on the acquisition/invoice cost reported on the claim.
- **Medicare modifiers for oncology**: For PET scans done for oncologic conditions, the PET procedure code (not A9552) must be appended with a specific modifier to indicate the stage of treatment, such as **PI**: To inform the initial treatment strategy or **PS**: To inform the subsequent treatment strategy (e.g., restaging or monitoring recurrence).
- **Units**: A9552 is billed per study dose (up to 45 millicuries), meaning typically one unit is reported, regardless of the exact millicurie amount injected.
## **Other relevant codes**
- **A9598**: Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified
- **A9555**: Rubidium Rb-82, diagnostic, per study dose
- **78815**: PET with concurrently acquired CT; skull base to mid-thigh
- **78816**: PET with concurrently acquired CT; whole body
- **78814**: PET with concurrently acquired CT; limited area
Frequently asked questions
