Does A9520 require prior authorization?

No, A9520 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for A9520?

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

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`A9520`, Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries

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 document medical necessity including relevant medical history, physical examination findings, and results of pertinent diagnostic tests or procedures supporting the clinical diagnosis and specific reason for the study.
All segments of the cardiovascular nuclear medicine service must have a formal interpretation and report documented in the medical record.

When CPT 78472 and add-on 78496 are submitted with perfusion codes 78451-78454, the formal reports must explicitly state that simultaneous first-pass cardiac function studies were performed and that the laboratory has equipment capability to perform such studies.

Key Coverage Criteria

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.
Simultaneous cardiac function studies using the first-pass technique performed with perfusion imaging (CPT 78451-78454) and reported with CPT 78472 and add-on 78496 are covered when the formal report documents that first-pass cardiac function studies were performed and the laboratory is equipped to perform them.
Myocardial perfusion imaging to assess the functional and prognostic importance of angina.
Diagnostic evaluation of chest pain when ECG is uninterpretable or equivocal due to drug effects, bundle branch block, or left ventricular hypertrophy.
Assessment of congenital anomalies of the coronary arteries using cardiovascular nuclear imaging.

3 Active Policies

NGS-J6-L33560, Cardiovascular Nuclear Medicine

A56743, Billing and Coding: Cardiovascular Nuclear Medicine

NGS-JK-L33560, Cardiovascular Nuclear Medicine

`A9520`, Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

A9520, Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

`A9520`, Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries