Does A9590 require prior authorization?

Yes, A9590 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for A9590?

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

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`A9590`, Iodine i-131, iobenguane, 1 millicurie

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Carefully check state regulations and/or the member contract.

Key Coverage Criteria

Coverage of injectable oncology medications is based on NCCN Compendium Categories of Evidence and Consensus (1, 2A, 2B = proven/medically necessary; 3 = unproven/not medically necessary); if NCCN is unavailable, base decisions on FDA labeling.
Myocardial sympathetic innervation imaging with iodine-123 MIBG is not covered for heart failure (considered experimental/investigational/unproven).

Coverage is restricted: myocardial sympathetic innervation imaging with iodine 123 meta-iodobenzylguanidine is considered experimental, investigational and/or unproven for use in individuals with heart failure.

Coverage is provided for injectable oncology medications listed in the NCCN Compendium with Categories of Evidence and Consensus of 1, 2A, or 2B as proven and medically necessary; categories with 3 are unproven and not medically necessary.

Coverage is provided for injectable oncology medications listed in the NCCN Compendium with Categories of Evidence and Consensus of 1, 2A, or 2B as proven and medically necessary; Category 3 is unproven and not medically necessary. If NCCN has no compendium, coverage determinations are based on FDA labeling.

Indication: Strontium-89 is medically necessary for symptomatic bone metastases when both: (1) Confirmed osteoblastic bone metastases from solid organ cancer; (2) Pain not adequately controlled by conventional therapy.

9 Active Policies

EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-0414D494E567, Health Partners Plans Radiation Therapy Code List - Effective 01/01/2025

UHC-POL-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage

BCBSIL-RAD604.012, Myocardial Sympathetic Innervation Imaging in Individuals With Heart Failure

BCBSMT-RAD604.012, Myocardial Sympathetic Innervation Imaging in Individuals With Heart Failure

BCBSNM-RAD604.012, Myocardial Sympathetic Innervation Imaging in Individuals With Heart Failure

BCBSOK-RAD604.012, Myocardial Sympathetic Innervation Imaging in Individuals With Heart Failure

UMR-POL-UMR-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage

SUREST-POL-SUREST-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage

CARELON-theranostics-therapeutic-radiopharmaceuticals-2026-04-04, Theranostics Therapeutic Radiopharmaceuticals

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A9590, Iodine i-131, iobenguane, 1 millicurie