2025 HCPCS code A9500
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diagnostic - Radiopharmaceuticals Diagnostic and Therapeutic Radiopharmaceuticals Feed
Supply of a single dose of Technetium Tc-99m sestamibi for nuclear medicine imaging to detect coronary artery disease or evaluate breast lesions.
Medical necessity is established by the presence of clinical symptoms or findings suggesting coronary artery disease or a suspicious breast lesion requiring further evaluation.The nuclear medicine study using Technetium Tc-99m sestamibi provides essential information for diagnosis and treatment planning.
The physician is responsible for ordering the radiopharmaceutical, administering the intravenous injection of Technetium Tc-99m sestamibi, interpreting the resulting images, and providing a diagnosis based on the nuclear medicine study.
In simple words: This code covers the cost of a special medicine (Technetium Tc-99m sestamibi) used in a type of scan to check for heart disease or problems in the breast.The doctor gives you an injection of this medicine, then takes pictures to help diagnose the problem.
This HCPCS code represents the supply of a single dose of Technetium Tc-99m sestamibi, a myocardial perfusion agent used in nuclear medicine imaging.It is used to detect coronary artery disease (CAD) and to evaluate breast lesions in patients with abnormal mammograms or palpable breast masses. The radiopharmaceutical is administered intravenously, followed by imaging to assess perfusion. This code applies only to the supply of the single dose required for one imaging study.
Example 1: A patient presents with chest pain and suspected coronary artery disease. The physician orders a myocardial perfusion imaging (MPI) study using Technetium Tc-99m sestamibi to assess the extent of coronary artery blockage., A mammogram reveals an abnormality in a patient's breast.The physician orders a nuclear medicine scan with Technetium Tc-99m sestamibi to further evaluate the lesion and determine whether it is benign or malignant., A patient with a palpable breast mass undergoes a nuclear medicine study with Technetium Tc-99m sestamibi to better characterize the mass and guide treatment decisions.
* Physician's order for Technetium Tc-99m sestamibi.* Documentation of the intravenous administration of the radiopharmaceutical.* Images from the nuclear medicine scan.* Radiologist's report interpreting the scan results.* Clinical indication for the study (e.g., chest pain, abnormal mammogram, palpable breast mass).
** This code is for the supply of the radiopharmaceutical only.Separate codes exist for the administration and interpretation of the nuclear medicine study.
- Payment Status: Active
- Specialties:Cardiology, Nuclear Medicine, Radiology, Oncology
- Place of Service:Hospital Outpatient, Ambulatory Surgical Center, Nuclear Medicine Clinic