All Nuclear Medicine Diagnostic | HCPCS | Category | ||||
---|---|---|---|---|---|---|
All Tc-99m diagnostic | Tc-99m MPI diagnostic | All non-Tc-99m/non-PET diagnostic | All PET diagnostic | Nuclear medicine diagnostic (non-PET) | ||
Sestamibi (Cardiolite) | A9500 | X | X | X | ||
Tetrofosmin (Myoview) | A9502 | X | X | X | ||
Tl-201 chloride | A9505 | X | X | |||
N-13 ammonia | A9526 | X | ||||
Rb-82, diagnostic, per study dose to 60 mCi | A9555 | X | ||||
Medronate (MDP) | A9503 | X | X | |||
Tc-99m Oxidronate (TechneScan, HDP) | A9561 | X | X | |||
Pyrophosphate | A9538 | X | X | |||
Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries | A9580 | X | ||||
Disofenin (Hepatolite) | A9510 | X | X | |||
Mebrofenin (Choletec) | A9537 | X | X | |||
Mertiatide (MAG-3) | A9562 | X | X | |||
Succimer (DMSA) | A9551 | X | X | |||
Tc-99m glucoheptonate (glucoheptate) | A9550 | X | X | |||
Tc-99m pentatate (DTPA) | A9539 | X | X | |||
I-125 sodium iothalamate (Glofil-125) | A9554 | X | X | |||
I-123 NaI, per 100 uCi, capsules, diagnostic | A9516 | X | X |
I-123 NaI per mCi, diagnostic | A9509 | X | X | |||
I-131 NaI capsule per mCi, diagnostic | A9528 | X | X | |||
I-131 NaI solution per mCi, diagnostic | A9529 | X | X | |||
I-131 NaI per uCi | A9531 | X | X | |||
Pertechnetate per mCi | A9512 | X | X | |||
Macroaggregated albumin (MAA) | A9540 | X | X | |||
Xe-133 | A9558 | X | X | |||
Tc-99m pentatate aerosol | A9567 | X | X | |||
In-111 pentetreotide (Octreoscan) | A9565/9572 | X | X | |||
I-131 iobenguane (MIBG), diagnostic, per 0.5 mCi | A9508 | X | X | |||
I -123 iobenguane MIBG, diagnostic, up to 15 mCi | A9582 | X | X | |||
Fluorodeoxyglucose F-18 FDG, diagnostic | A9552 | X | ||||
Exametazime (Ceretec) | A9521 | X | X | |||
Bicisate (Neurolite) | A9557 | X | X | X | ||
I-123 ioflupane (DATscan) | A9584 | X | ||||
In-111 Pentetate, Diagnostic CSF, per 0.5 mCi | A9548 | X | ||||
F18 Florbetapir (Amyvid) | A9586 | X | ||||
In-111 oxyquinoline (oxine) | A9547 | X | X | |||
Exametazime (HMPAO) autologous WBC’s | A9569 | X | X |
All Nuclear Medicine Diagnostic | HCPCS | Category | ||||
---|---|---|---|---|---|---|
All Tc-99m diagnostic | Tc-99m MPI diagnostic | All non-Tc-99m/non-PET diagnostic | All PET diagnostic | Nuclear medicine diagnostic (non-PET) | ||
In-111 labeled autologous WBC’s | A9570 | X | ||||
Sulfur colloid | A9541 | X | X | |||
Labeled red cells | A9560 | X | X | |||
Ga-67 citrate per mCi | A9556 | X | X | |||
In-111 ibiritumomab tiuxetan (Zevalin), diagnostic | A9542 | X | X | |||
I-131 tositumomab (Bexxar), diagnostic | A9544 | X | X | |||
Co57/58 cyanocobalamin | A9546 | X | X | |||
Cr-51 sodium chromate | A9553 | X | X | |||
Co-57 cyanocobalamin | A9559 | X | X | |||
Arcitumomab (CEA Scan) | A9568 | X | X | |||
In-111 capromab pendetide (Prostascint) | A9507 | X | X | |||
In-111 labeled autologous platelets | A9571 | X | X | |||
I-131 human serum albumin | A9524 | X | X |
NOTE: Categories correspond to the labels used in Figures 6.1-6.3 and 6.6 and 6.7 in Chapter 6.