Does A9555 require prior authorization?

No, A9555 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for A9555?

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

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`A9555`, Rubidium rb-82, diagnostic, per study dose, up to 60 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

Claims for stress tests performed as preoperative evaluation of asymptomatic, moderate-risk patients must include medical record documentation of at least one of: diabetes mellitus with complications; peripheral vascular disease; aortic aneurysm; or cerebrovascular disease.
When PET Rb-82 is performed after an equivocal, technically uninterpretable, or discordant SPECT, the clinical reason and medical necessity for PET must be clearly documented in the patient's medical record.

Physician supervision must be documented: MPI and blood pool imaging require general supervision by a physician licensed to administer radioactive materials, and cardiac stress procedures performed with MPI require direct supervision by a qualified physician who provides the listed medical expertise and treatments.

Key Coverage Criteria

Preoperative cardiac stress testing with radionuclide imaging for asymptomatic patients deemed at moderate risk is covered only if the medical record documents at least one of the following: diabetes mellitus with complications; peripheral vascular disease; aortic aneurysm; or cerebrovascular disease.
Diagnose CAD in individuals with at least intermediate-risk when PET perfusion imaging is used due to indeterminate or suboptimal noninvasive tests (e.g., indeterminate SPECT or suboptimal body habitus/technical factors).
Medically necessary for diagnosing CAD in individuals with at least intermediate pretest risk when (a) there are indeterminate noninvasive tests or (b) SPECT is expected to be suboptimal due to body habitus or technical problems.
Medically necessary for assessing myocardial perfusion to diagnose CAD in individuals with intermediate CAD risk when there are indeterminate noninvasive tests or anticipated suboptimal SPECT quality (e.g., BMI >35 kg/m2, large breasts/implants, prior indeterminate SPECT, prior MI).
PET scanning is medically necessary to assess myocardial perfusion to diagnose CAD in individuals with intermediate risk when there are indeterminate noninvasive tests or anticipated suboptimal SPECT quality.
Myocardial perfusion imaging (MPI/SPECT) is covered for diagnosis and management of coronary artery disease (CAD), including evaluation of atypical chest pain, abnormal or suspected false-positive stress ECG, and other symptoms suspicious for CAD.

7 Active Policies

PALMETTO-JJ-L33457, Cardiac Radionuclide Imaging

PALMETTO-JM-L33457, Cardiac Radionuclide Imaging

BCBSMT-RAD605.001, Cardiac Applications of Positron Emission Tomography Scanning

BCBSNM-RAD605.001, Cardiac Applications of Positron Emission Tomography Scanning

BCBSOK-RAD605.001, Cardiac Applications of Positron Emission Tomography Scanning

BCBSIL-RAD605.001, Cardiac Applications of Positron Emission Tomography Scanning

A56476, Billing and Coding: Cardiac Radionuclide Imaging

`A9555`, Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

A9555, Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

`A9555`, Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries