2008 Radiopharmaceutical Pricing
| HCPCS Code | Description | JANUARY 2008 | Old code | Also Known As |
|---|---|---|---|---|
| A9500 | Technetium TC99M Sestamibi/Cardiolite, Diagnostic, per study dose, up to 40 MCI | $121.70 | A9500 | Cardiolite |
| A9501 | Technetium TC-99m Teboroxime, Diagnostic, per study dose | Invoice | add 1/1/2008 | |
| A9502 | Technetium TC99M Tetrofosmin/Myoview, Diagnostic, per study dose , up to 40 MCI | Effective July 1, 2008 $111.32 Prior to July 1, 2008 $117.85 |
A9502 | |
| A9503 | Technetium TC99M Medronate/MPI MDP, Diagnostic, per study dose, up to 30 MCI | $54.93 | A9503 | MDP |
| A9504 | Technetium TC99M/Acutect/Apcitide Kit, Diagnostic, per study dose, up to 20 MCI | $460.00 | A9504 | |
| A9505 | Thallous Chloride TL 201, Diagnostic, per MCI | $88.40 | A9505 | |
| A9507 | Indium IN 111/Capromab Pendetide; Prostascint, Diagnostic, per study dose, up to 20 MCI | $3,568.78 | A9507 | Prostascint |
| A9508 | Iobenguane Sulfate I-131, Diagnostic, per .5 MCI | $558.00 | A9508 | |
| A9509 | Iodine I-123 Sodium Iodide, Diagnostic, per millicurie | $88.57 | add 1/1/2008 | |
| A9510 | Technetium TC99M Disofenin/Hepatolite, Diagnostic, per study dose, up to 15 MCI | $43.12 | A9510 | HEPATOLITE |
| A9512 | Technetium TC99M Pertechnetate, Diagnostic, per MCI | Invoice | A9512 | NATC04 |
| A9516 | I-123 Sodium Iodide Capsule(s), Diagnostic, per 100 microcuries | $92.99 | A9516 | |
| A9517 | I-131 Sodium Iodide Capsule(s), therapeutic, per MCI | Invoice | A9517 | |
| A9521 | Technetium TC99M Exametazine, Diagnostic, per study dose, up to 25 MCI | $567.61 | A9521 | HMPAO, WBC, CERETEC |
| A9524 | Iodinated I-131 Serum Albumin, Diagnostic, per 5 microcuries | $59.09 | A9524 | |
| A9528 | Iodine I-131 Sodium Iodide Capsule(s), Diagnostic, per MCI | $40.38 | A9528 | |
| A9529 | Iodine I-131 Sodium Iodide Solution, Diagnostic, per MCI | Invoice | A9529 | |
| A9530 | Iodine I-131 Sodium Iodide Solution, therapeutic, per MCI | Invoice | A9530 | |
| A9531 | Iodine I-131 Sodium Iodide, Diagnostic, per MCI (up to 100 MCI) | Invoice | A9531 | |
| A9532 | Iodine I-125 Serum Albumin, Diagnostic, per 5 microcuries | Invoice | A9532 | |
| A9535 | Methylene Blue, 1 cc | $6.43 | A9535 | |
| A9536 | Technetium TC 99M Depreotide, Diagnostic, per study does, up to 35 MCI | $736.00 | A9511 | |
| A9537 | Technetium TC 99M Mebrofenin, Diagnostic, per study dose, up to 15 MCI | $63.06 | A9513 | CHOLETEC |
| A9538 | Technetium TC 99M Pyrophosphate, Diagnostic, per study dose, up to 25 MCI | $24.70 | A9514 | PYP |
| A9539 | Technetium TC 99M Pentetate, Diagnostic, per study dose, up to 25 MCI | $16.25 | A9515 | DTPA |
| A9540 | Technetium TC 99M Macroaggregated Albumin, Diagnostic, per study dose, up to 10 MCI | $21.53 | A9519 | MAA |
| A9541 | Technetium TC 99M Sulfurcolloid, Diagnostic, per study dose, up to 20 MCI | $53.20 | A9520 | |
| A9542 | Indium IN-111 Ibritumomab Tiuxetan, Diagnostic, per study dose, up to 5 MCI | $2,769.63 | A9522 | |
| A9543 | Yttrium Y-90 Ibritumomab Tiuxetan, therapeutic, per treatment dose, up to 40 MCI | Invoice | A9523 | |
| A9544 | Iodine I-131 Tositumomab, Diagnostic, per study dose | Invoice | A9533 | |
| A9545 | Iodine I-131 Tositumomab, therapeutic, per treatment dose | Invoice | A9534 | |
| A9546 | Cobalt CO-57/58, Cyanocobalamin, Diagnostic, per study dose, up to 1 microcurie | Invoice | A9546 | |
| A9547 | Indium IN 111 Oxyquinoline, Diagnostic, per 0.5 MCI | $414.00 | A9547 | |
| A9548 | Indium IN 111 Pentetate, Diagnostic, per 0.5 MCI | $248.40 | ||
| A9549 | Technetium TC 99M Arcitumomab, Diagnostic, per study dose, up to 25 MCI | $1,196.00 | A9549 | |
| A9550 | Technetium TC 99M Sodium Gluceptate, Diagnostic, per study dose, up to 25 MCI | Invoice | Q3006 | |
| A9551 | Technetium TC 99M Succimer, Diagnostic, per study dose, up to 10 MCI | $126.63 | A9551 | |
| A9552 | Fluorodeoxyglucose F-18 FDG, Diagnostic, per study dose up to 45 MCI | $240.00 | A9552 | |
| A9553 | Chromium Cr-51 sodium chromate, Diagnostic, per study dose, up to 250 microcuries | $371.89 | A9553 | |
| A9554 | Iodine I-125 Sodium Iothalamate, Diagnostic, per study dose, up to 10 microcuries | Invoice | A9554 | |
| A9555 | Rubidium RB-82, Diagnostic, per study dose, up to 60 millicuries | $250.00 | A9555 | |
| A9556 | Gallium Ga-67Citrate, Diagnostic, per millicuire | $32.04 | Q3002 | GALLIUM CITRATE |
| A9557 | Technetium TC 99M Bicisate, Diagnostic, per study dose, up to 25 MCI | Invoice | Q3003 | |
| A9558 | Xenon Xe-133 gas, Diagnostic, per 10 MCI | $38.96 | Q3004 | NAG 3/MAG 3 |
| A9559 | Cobalt CO-57 Cyanocobalamin, Oral, Diagnostic, per study dose up to 1microcurie | Invoice | Q3012 | |
| A9560 | Technetium TC 99M Labeled Red Blood Cells, Diagnostic, per study dose, up to 30 MCI | $106.48 | Q3010 | ULTRATAG |
| A9561 | Technetium TC 99M Oxidronate, Diagnostic, per study dose, up to 30 MCI | $50.16 | Q3009 | HDP |
| A9562 | Technetium TC 99M Mertiatide, Diagnostic, per study dose, up to 15 MCI | $588.24 | Q3005 | |
| A9563 | Sodium Phosphate P-32, therapeutic, per MCI | $347.56 | Q3007 | |
| A9564 | Chromic Phosphate P-32, suspension, therapeutic, per MCI | $331.13 | Q3011 | |
| A9565 | Indium In-111 Pentetreotide, Diagnostic, per MCI | Q3008 | deleted 12/31/2007 | |
| A9566 | Technetium TC 99M Fanolesomab, Diagnostic, per study dose up to 25 MCI | Invoice | A9566 | |
| A9567 | Technetium TC 99M Pentetate, Diagnostic, aerosol, per study dose, up to 75 MCI | Invoice | A9567 | |
| A9569 | Technetium TC-99m exametazime labeled autologous white blood cells, Diagnostic, | Invoice | add 1/1/2008 | |
| A9570 | Indium IN-111 labeled autologous white blood cells, Diagnostic, per study dose | Invoice | add 1/1/2008 | |
| A9571 | Indium IN-111 labeled autologous platelets, Diagnostic, per study dose | Invoice | add 1/1/2008 | |
| A9572 | Indium IN-111 Pentetreotide, Diagnostic, per study dose, up to 6 millicuries | Invoice | add 1/1/2008 | |
| A9576 | Injection, Gadoteridol, (Prohance Multipack), per ml | $2.463 | add 1/1/2008 | |
| A9577 | Injection, Gadobenate Dimeglumine (Multihance), per ml | $2.852 | add 1/1/2008 | |
| A9578 | Injection, Gadobenate Dimeglumine (Multihance Multipack), per ml | $2.677 | add 1/1/2008 | |
| A9579 | Injection, Gadolinium-based magnetic resonance contrast agent, not otherwise | $2.549 | add 1/1/2008 | |
| A9600 | Strontium Sr--89 Chloride/Metastron, therapeutic, per MCI | $882.79 | A9600 | |
| A9605 | Quadramet / Samarium Sm 153 Lexidronamm, therapeutic, per 50 MCI | $1,692.99 | A9605 | quadramet |
| J1675 | Histrelin 10 mg | $1,140.00 | ||
| Q2004 | Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 mg | $29.45 |
