Does A9592 require prior authorization?

No, A9592 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for A9592?

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

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`A9592`, Copper cu-64, dotatate, diagnostic, 1 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

For IPMN evaluation with FDG-PET/CT: documentation of imaging and clinical factors used in malignancy prediction (e.g., main pancreatic duct diameter, serum carcinoembryonic antigen [CEA] value, neutrophil-to-lymphocyte ratio [NLR], and PET accumulation/SUV when performed) because studies identified combinations of these as predictors.

General: where PET is used to influence management (e.g., selection for surgery, targeted radioligand therapy such as Pluvicto), documentation should include prior imaging findings, treatment history, specific clinical question to be answered by PET, and how PET findings will impact treatment decisions (examples appear throughout the evidence summaries).

For cardiac PET used in place of SPECT: documentation that member meets medical necessity criteria for a cardiac SPECT (see CPB 0376) or indication that PET is being used for assessment after cardiac transplant.

Key Coverage Criteria

Evaluation of Coronary Artery Disease: PET scans using rubidium-82 (Rb-82) or N-13 ammonia done at rest or with pharmacological stress for non-invasive imaging of the perfusion of the heart for the diagnosis and management of members with known or suspected coronary artery disease when either (a) the PET scan is used in place of, but not in addition to, a single photon emission computed tomography (SPECT) in persons who meet medical necessity criteria for a cardiac SPECT (see CPB 0376) or (b) fo [...]
Absolute quantitation of myocardial blood flow (AQMBF) as a medically necessary adjunct to cardiac PET when criteria for rest/stress perfusion for coronary artery disease are met.
Assessment of Myocardial Viability: FDG-PET for the determination of myocardial viability prior to re-vascularization, either as a primary or initial diagnostic study or following an inconclusive SPECT.
Cardiac Sarcoid: FDG-PET to identify and monitor response to therapy for established or strongly suspected cardiac sarcoid.
Screening for paraneoplastic neurological syndromes
Pancreatic adenocarcinoma

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`A9592`, Copper cu-64, dotatate, diagnostic, 1 millicurie

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

A9592, Copper cu-64, dotatate, diagnostic, 1 millicurie

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

`A9592`, Copper cu-64, dotatate, diagnostic, 1 millicurie