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Coding for PET

PET radiopharmaceuticals have their own unique HCPCS codes that can be reported on claims.  Please be advised that CMS prohibits the use of the miscellaneous code A4641 Radiopharmaceutical, diagnostic, not otherwise classified, on PET claims.

Below is a list of PET radiopharmaceuticals and their respective codes:

Radiopharmaceutical Trade NameHCPCS Code
Nitrogen n-13 AmmoniaAmmoniaA9526
Fluorodeoxyglucose F-18 FDGF18 FDGA9552
Rubidium rb-82CardioGen-82A9555
Sodium Fluoride F-18F18, NaF, Sodium FluorideA9580
Choline C-11C-11 CholineA9515
Fluciclovine F-18Axumin™A9588
Gallium ga-68 dotatateNETSPOT™A9587
Florbetapir F-18Amyvid™A9586
Flutemetamol F-18Vizamyl™Q9982
Florbetaben F-18NeuraCeq™Q9983

 

Newly FDA-approved PET tracers without an assigned HCPCS code can use one of the following codes:
A9597 Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified
A9598  Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified

 

For 2018, CMS has discontinued the  HCPCS code
A9599 Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (PET) imaging, per study dose

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