HCPCS Code Details - A9577

HCPCS Level II Code
Transportation Services Including Ambulance, Medical & Surgical Supplies
HCPCS Code A9577
Description

Long description:
Injection, gadobenate dimeglumine (multihance), per ml

Short description:
Inj multihance

HCPCS Modifier1
HCPCS Pricing indicator 51 - Drugs
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Coverage code C - Carrier judgment
BETOS2 code I1E - Standard imaging - nuclear medicine
HCPCS Action code N - No maintenance for this code
Type of service 4 - Diagnostic radiology
Effective date Effective Jan 01, 2008
Date added Added Jan 01, 2008
HCPCS Coding Procedures

HCPCS Modifiers

In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters.

Example: E0260-NU - Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress
NU” identifies the hospital bed as new equipment

ASP Drug pricing - A9577

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
1 ML 1.821 - - - - - -
January 1, 2024 - March 31, 2024 1 ML 1.841 - - - - - -
October 1, 2023 - December 31, 2023 1 ML 1.819 20% - - - - -
Jul 1, 2023 - Sep 30, 2023 1 ML 1.813 20% - - - - -
April 1, 2023 - June 30, 2023 1 ML 1.834 20% - - - - -

See also

  • HCPCS A9576 · Injection, gadoteridol, (prohance multipack), per ml

  • HCPCS A9578 · Injection, gadobenate dimeglumine (multihance multipack), per ml


1 Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

2 BETOS stands for “Berenson-Eggers Type Of Service”