HCPCS Code Details - A9573

HCPCS Level II Code
Transportation Services Including Ambulance, Medical & Surgical Supplies
HCPCS Code A9573
Description

Long description:
Injection, gadopiclenol, 1 ml

Short description:
Inj, gadopiclenol, 1 ml

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 Oct 01, 2023
Date added Added Oct 01, 2023
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 - A9573

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
October 1, 2024 - December 31, 2024 1 ML 4.168 - - - - - -
Jul 1, 2024 - Sep 30, 2024 1 ML 3.911 - - - - - -
April 1, 2024 - June 30, 2024 1 ML 5.126 - - - - - -

See also

  • HCPCS A9572 · Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries

  • HCPCS A9575 · Injection, gadoterate meglumine, 0.1 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”