HCPCS Code A9575: Injection, Gadoterate Meglumine, 0.1 mL

## **Documentation requirements for HCPCS code a9575** Accurate documentation must support the medical necessity of gadoterate meglumine use during an MRI. The patient’s medical record should include: - The diagnosis or condition requiring contrast-enhanced MRI (e.g., brain tumor, multiple sclerosis, vascular malformation). - Name of the agent (gadoterate meglumine), strength, concentration, and route of administration (intravenous). - Total dose administered in milliliters, converted into 0.1 mL units for billing. - Signed and dated order from the radiologist or treating physician authorizing the use of contrast. - MRI performed, anatomical area imaged, and reason contrast was required. - Document renal function assessment (since gadolinium agents carry risk of nephrogenic systemic fibrosis) and any adverse reactions if applicable.

## **HCPCs code a9575 billing requirements** Billing for A9575 requires strict alignment with administered dosage and claim form detail: - Report per 0.1 mL unit of gadoterate meglumine administered. - Ensure the units billed exactly match the dosage given, as documented in the MRI procedure note. - Include the appropriate ICD-10-CM diagnosis code supporting the medical necessity for contrast-enhanced imaging. - Submit on the correct form, either using the CMS-1500 for professional services or UB-04 for facility billing. - National Drug Code (NDC) is required by many payers for drug identification and reimbursement. - Report actual cost per payer rules; some carriers require invoice submission. - Medicare and most commercial payers cover the contrast agent's fee when medical necessity is demonstrated. Note that Medicaid and NC Health Choice programs cover gadoterate meglumine injection, for intravenous use (Clariscan), under the Physician’s Administered Drug Program (PADP) when billed based on the HCPCS code A9575.

## **Applicable modifiers** Modifiers may be required when billing for HCPCS code A9575 to clarify how the drug was used and ensure compliance with Medicare and payer-specific policies. Proper use of modifiers helps avoid denials and supports accurate reimbursement. - JW modifier: Use when reporting discarded amounts from a single-use vial. - JZ modifier: Append if no drug was discarded (Medicare requirement). - KX modifier: May be required to confirm medical necessity has been met per local coverage determinations (LCDs).

## **Other relevant codes** Relevant HCPCS codes to A9575 include: - **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 MRI contrast agent, NOS, per mL - **A9581** – Injection, gadoxetate disodium, 1 mL - **A9583** – Injection, gadofosveset trisodium, 1 mL