Does A9512 require prior authorization?

No, A9512 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for A9512?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`A9512`, Technetium tc-99m pertechnetate, diagnostic, per millicurie

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

The patient's medical record must include the ordering provider's assessment related to the patient's complaint for that visit.
The medical record must include relevant medical history and results of pertinent tests and procedures.

When using the -GA modifier and ABN, Form CMS-R-131 must be signed by the beneficiary (or properly witnessed if the beneficiary refuses to sign) to indicate acceptance of payment responsibility.

Key Coverage Criteria

For services that require a referring or ordering physician, the claim must report the referring/ordering physician's name and NPI.
Claims must include a valid ICD-10-CM diagnosis code that best describes the patient's condition for which the service was performed; otherwise the claim will be returned as incomplete under SSA Section 1833(e).
For diagnostic tests, the claim should report the test result if known, otherwise report the symptoms that prompted the test.
If a service is likely to be non-covered, an Advance Beneficiary Notice (ABN) may be used and the appropriate modifier (GA, GX, GY, or GZ) should be appended to the claim as applicable.
Cardiovascular nuclear medicine testing is reimbursable for risk assessment or re-evaluation in asymptomatic patients or patients with stable symptoms who have known atherosclerotic heart disease on catheterization or SPECT perfusion imaging, provided the patient has not undergone a revascularization procedure within the prior 2 years.
Blood pool scan to assess left ventricular ejection fraction prior to implantation of an implantable cardioverter-defibrillator (ICD) or biventricular pacemaker is covered when the medical record documents the intended plan for device insertion and the test result.

6 Active Policies

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

CGS-J18-L33960, Cardiovascular Nuclear Medicine

J18

NGS-J6-L33560, Cardiovascular Nuclear Medicine

A56743, Billing and Coding: Cardiovascular Nuclear Medicine

NGS-JK-L33560, Cardiovascular Nuclear Medicine

A56494, Billing and Coding: Cardiovascular Nuclear Medicine

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A9512, Technetium tc-99m pertechnetate, diagnostic, per millicurie