HealthCare News

Radiopharmaceuticals for Nuclear Medicine

Issue: #397 NOV2017

Topic: Reimbursement


When administering radiopharmaceuticals for nuclear medicine procedures, units should be billed according to the HCPCS code description and should be consistent with the quantity of the radiopharmaceutical administered to the patient. The code description of the radiopharmaceutical includes the unit value. These unit values vary with each code. Unit values may be per millicurie (mci), per specific number of millicuries, per microcurie (µci), per dose, per unit dose and per vial. Fee schedule rates are based on the unit value in the code description. The following are two examples of billing for radiopharmaceuticals:

  • Six mci of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m pertechnetate (A9512) are administered. Six units of A9512 would be billed since the code description states “per millicurie.”
  • One dose of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m sestamibi (A9500) is administered. One (1) unit of A9500 would be billed since the code description states “per study dose.”

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