HCPCS Code Details - A9576

HCPCS Level II Code
Transportation Services Including Ambulance, Medical & Surgical Supplies
HCPCS Code A9576
Description

Long description:
Injection, gadoteridol, (prohance multipack), per ml

Short description:
Inj prohance multipack

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 - A9576

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
October 1, 2017 - December 31, 2017 1 ML 1.729 - - - - - -
July 1, 2017 - September 30, 2017 1 ML 1.751 - - - - - -
April 1, 2017 - June 30, 2017 1 ML 1.729 - - - - - -
January 1, 2017 - March 31, 2017 1 ML 1.626 - - - - - -
October 1, 2016 - December 31, 2016 1 ML 1.611 - - - - - -

See also

  • HCPCS A9575 · Injection, gadoterate meglumine, 0.1 ml

  • HCPCS A9577 · Injection, gadobenate dimeglumine (multihance), 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”