Ask the Experts
Nuclear Medicine and Charging for Radiopharmaceuticals
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The Ambulatory Payment Classification (APC) used to reimburse for Nuclear Medicine procedures under The Outpatient Prospective Payment System (OPPS) does not include the cost of many radiopharmaceutical agents. For this reason, hospitals need to know when they must generate separate charges for radiopharmaceuticals or isotopes that are used in conjunction with these procedures.
Radiopharmaceuticals
The hospital charge master should contain specific charges for all radiopharmaceuticals that are used in conjunction with Nuclear Medicine procedures.
The table below presents the 2006 HCPCS Level II for radiopharmaceuticals. The status indicator and the applicable UB-92 revenue codes are also included. The status indicator is part of OPPS and represents whether payment is by APC, by fee schedule, or not paid. The UB-92 revenue code is a three digit number that describes the type of service provided, e.g. 343 Nuclear Medicine — Diagnostic Radiopharmaceutical, or 344 Nuclear Medicine — Therapeutic Radiopharmaceutical.
For the table below:
** Status Indicator N means that this is an incidental service and not separately paid under OPPS.
** Status Indicator H means that this is a paid under OPPS by one of the following methods:
- Separate cost-based Pass-Through payment not subject to coinsurance
- Separate cost-based Non-Pass-Through payment
| CPT/HCPCS CODE | DESCRIPTION | STATUS INDICATOR | REV CODE |
| A4641 | NM RADIOPHARMACEUTICAL DIAGNOSTIC | N | 343 |
| A4642 | NM SATUMOMAB PENDETIDE PER DOSE DX | H | 343 |
| A9500 | NM TC-99M SESTAMIBI PER DOSE DX | H | 343 |
| A9502 | NM TC-99M TETROFOSMIN PER UNIT DOSE DX | H | 343 |
| A9503 | NM TC-99M MEDRONATE UP TO 30 MCI DX | N | 343 |
| A9504 | NM TC-99M APCITIDE PER STUDY DOSE UP TO 20 MCI DX | H | 343 |
| A9505 | NM THALLOUS CHLORIDE TL-201 PER MCI DX | H | 343 |
| A9507 | NM I-111 CAPROMAB PENDETIDE PER DOSE DX | H | 343 |
| A9508 | NM I-131 PER 0.5 MCI DX | H | 343 |
| A9510 | NM TC-99M DISOFENIN UP TO 15 MCI DX | H | 343 |
| A9512 | NM TC-99M PERTECHNETATE PER MCI DX | N | 343 |
| A9516 | NM I-123 CAPSULE PER 100 UCI DX | H | 343 |
| A9517 | NM I-131 CAPSULE PER MCI TX | H | 344 |
| A9521 | NM TC-99M EXAMETAZINE PER DOSE DX | H | 343 |
| A9524 | NM I-131 SERUM ALBUMIN PER 5 UCI DX | H | 343 |
| A9526 | NM AMMONIA N-13 PER DOSE | H | 343 |
| A9528 | NM I-131 CAPSULE PER MCI DX | H | 343 |
| A9529 | NM I-131 SOLUTION PER MCI DX | H | 343 |
| A9530 | NM I-131 SOLUTION PER MCI TX | H | 344 |
| A9531 | NM I-131 SODIUM PER UCI (UP TO 100 UCI) DX | H | 343 |
| A9532 | NM I-125 SERUM ALBUMIN PER 5 UCI DX | H | 343 |
| A9536 | NM TC-99M DEPREOTIDE PER STUDY DOSE UP TO 35 MCI DX | H | 343 |
| A9537 | NM TC-99M MEBROFENIN PER STUDY DOSE UP TO 15 MCI DX | N | 343 |
| A9538 | NM TC-99M PYROPHOSPHATE PER STUDY DOSE UP TO 25 MCI DX | N | 343 |
| A9539 | NM TC-99M PENTETATE PER STUDY DOSE UP TO 25 MCI DX | N | 343 |
| A9540 | NM TC-99M MACROAGGREGATED ALBUMIN PER STUDY DOSE UP TO 10 MCI DX | N | 343 |
| A9541 | NM TC-99M SULFUR COLLOID PER STUDY DOSE UP TO 20 MCI DX | N | 343 |
| A9542 | NM I-111 IBRITUMOMAB TIUXETAN PER STUDY DOSE UP TO 5 MCI DX | H | 343 |
| A9543 | NM YTTRIUM Y-90 IBRITUMOMAB TIUXETAN PER TREATMENT DOSE UP TO 40 MCI TX | H | 344 |
| A9544 | NM I-131 TOSITUMOMAB PER STUDY DOSE DX | H | 343 |
| A9545 | NM I-131 TOSITUMOMAB PER TREATMENT DOSE TX | H | 344 |
| A9546 | NM COBALT CO-57/58 CYANOCOBALAMIN PER STUDY DOSE UP TO 1 UCI DX | N | 343 |
| A9547 | NM I-111 OXYQUINOLINE PER 0.5 MCI DX | H | 343 |
| A9548 | NM I-111 PENTETATE PER 0.5 MCI DX | H | 343 |
| A9549 | NM TC-99M ARCITUMOMAB PER STUDY DOSE UP TO 25 MCI DX | H | 343 |
| A9550 | NM TC-99M SODIUM GLUCEPTATE PER STUDY DOSE UP TO 25 MCI DX | H | 343 |
| A9551 | NM TC-99M SUCCIMER PER STUDY DOSE UP TO 10 MCI DX | H | 343 |
| A9552 | NM FLUORODEOXYGLUCOSE F-18 FDG PER STUDY DOSE UP TO 45 UCI DX | H | 343 |
| A9553 | NM CHROMIUM CR-51 SODIUM CHROMATE PER STUDY DOSE UP TO 250 UCI DX | H | 343 |
| A9554 | NM I-125 SODIUM IOTHALAMATE PER STUDY DOSE UP TO 10 MCI DX | H | 343 |
| A9555 | NM RUBIDIUM RB-82 PER STUDY DOSE UP TO 60 MCI DX | H | 343 |
| A9556 | NM GALLIUM GA-67 CITRATE PER MCI DX | H | 343 |
| A9557 | NM TC-99M BICISATE PER STUDY DOSE UP TO 25 MCI DX | H | 343 |
| A9558 | NM XENON XE-133 GAS PER 10 MCI DX | N | 343 |
| A9559 | NM COBALT CO-57 CYANOCOBALAMIN ORAL PER STUDY DOSE UP TO 1 UCI DX | N | 343 |
| A9560 | NM TC-99M LABELED RED BLOOD CELLS PER STUDY DOSE UP TO 30 MCI DX | H | 343 |
| A9561 | NM TC-99M OXIDRONATE PER STUDY DOSE UP TO 30 MCI DX | N | 343 |
| A9562 | NM TC-99M MERTIATIDE PER STUDY DOSE UP TO 15 MCI DX | H | 343 |
| A9563 | NM SODIUM PHOSPHATE P-32 PER MCI TX | H | 344 |
| A9564 | NM CHROMIC PHOSPHATE P-32 SUSPENSION PER MCI TX | H | 344 |
| A9565 | NM I-111 PENTETREOTIDE PER MCI DX | H | 343 |
| A9566 | NM TC-99M FANOLESOMAB PER STUDY DOSE UP TO 25 MCI DX | H | 343 |
| A9567 | NM TC-99M PENTETATE AEROSOL PER STUDY DOSE UP TO 75 MCI DX | H | 343 |
| A9600 | NM STRONTIUM-89 PER MCI TX | H | 344 |
| A9605 | NM SAMARIUM-153 LEXIDRONAM 50 MCI TX | H | 344 |
| A9699 | NM RADIOPHARMACEUTICAL THERAPEUTIC | N | 344 |