HCPCS Code Q9957: Injection, Perflutren Lipid Microspheres, per mL

Master Q9957 billing for Definity echo contrast agent. See units, CPT codes, modifiers, and documentation tips for office and hospital setting.

Use Code

## **What is an injection of perflutren lipid microspheres?** HCPCS code Q9957 is the long descriptor “Injection, perflutren lipid microspheres, per mL.” Perflutren lipid microspheres are an ultrasound echo contrast agent, often marketed under the brand name DEFINITY. These tiny gas-filled microbubbles are stabilized by a lipid shell and injected through a vein to enhance ultrasound signal during a cardiac procedure. When these microbubbles circulate in the cardiovascular system, they improve delineation of cardiac chambers, endocardial borders, and wall motion. A physician typically orders Q9957 during transthoracic echocardiography, transesophageal echocardiography, or stress echo when baseline images are suboptimal. The workflow generally includes IV insertion, probe placement, image acquisition, and real-time interpretation. In the hospital setting the supply is often packaged into the facility payment, but the drug still needs to appear on the claim so payers can track use.

## **Q9957 documentation requirements** Accurate records support payment and patient safety. Follow these tips: ### **Indication and diagnosis** Document why an echo contrast agent was required, such as poor acoustic windows or the need to better define endocardial borders. Link the indication to the ordered echocardiography procedure. ### **Dose, units, and route** Record the total milliliters administered and the route as an intravenous administration. Include start and stop times when the protocol requires them, and note any repeat injections during the same study. ### **Procedure linkage** Reference the exact echo procedure performed. Include the CPT codes used in the office or the C-codes used on outpatient facility claims so the contrast supply is clearly tied to the imaging service. ### **Safety and monitoring** Note vitals, any infusion-related events, and whether the patient tolerated the injection without complications. If an event occurred, describe management and outcome. ### **Billing narrative** For NOS reviews or payer requests, add a brief narrative that names the product, the total mL used, the number of units on the claim, and any discarded amount you will report.

## **Q9957 billing requirements** Report the drug supply in alignment with payer rules and the imaging code set. Remember the following when billing: ### **Units and rounding** Bill one unit of Q9957 for each 1 mL administered. If only a fractional mL remains in the vial, do not round up unless your payer has written instructions that allow rounding to the next whole unit. Bill only whole units on both the administered and discarded lines. ### **Physician office vs. facility** In a physician office, report the appropriate echocardiography CPT codes, such as a complete transthoracic study, and add Q9957 for the drug units used. In a hospital setting, use the contrast “C” codes for echo with contrast, such as C8929 when appropriate, and include Q9957 for tracking even when separate reimbursement is not available. ### **Packaging and Medicare** Under Medicare OPPS, the contrast supply is generally packaged with the imaging service, but the facility still needs to report Q9957. In non-facility settings some plans reimburse the supply separately. Check plan policies for coding information on separate payment. ### **Stress echo and repeats** When the contrast is used during stress echo, document the stage when it was given and the total units across rest and stress phases. Units must equal the total administered volume reflected in the final report. ### **Compliance checkpoints** Match the number of units to the documented milliliters. Ensure the claim date aligns with the date of service on the echo. Keep invoices available if requested by a payer audit.

## **Q9957 applicable modifiers** Use modifiers that communicate drug usage status when required by the payer. Here are some common ones: - **JW**: Use to report the amount of the drug discarded from a single-use vial when at least one whole unit is wasted and documented. - **JZ**: Use when no drug was discarded from a single-use vial on Medicare claims, when applicable under current policy.

## **Other relevant codes** Select the correct imaging code and the appropriate supply code for the agent used. - **C8929**: Transthoracic echocardiography with contrast, complete, including Doppler and color flow, hospital outpatient use. - **A9700**: Injectable contrast material for echocardiography, per study, used when a payer does not accept Q-codes. - **Q9955**: Injection, perflexane lipid microspheres, per mL. - **Q9956**: Injection, octafluoropropane microspheres, per mL. - **Q9950**: Sulfur hexafluoride lipid microspheres, per mL.

Frequently asked questions

No. Q9957 is a supply code tied to an echocardiography procedure. Bill it with the associated echo service in the office using CPT codes or with the appropriate C-code in the hospital setting. Many facility claims show packaged payment for the supply, but the drug should still be reported.

Bill the actual milliliters administered as whole units. If any whole-unit amount is discarded from a single-use vial, report that quantity on a separate line with the JW modifier. Do not round up partial milliliters unless your payer publishes instructions that permit rounding to the next unit.

Use the payer’s instructed alternative, which may be A9700 or an unlisted supply code with a clear narrative. Include the product name, total mL administered, and the related echo procedure. Contact the plan for written guidance to reduce denials.