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HCPCS A9516 · Level II · A code

A9516: Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries, HCPCS Level II A code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for A9516

Medicare payment
no PFS amount
PFS status C
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
4
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
35
35 hospital outpatient
LCDs and articles
0 / 0

TL;DR

HCPCS Level II A9516 reads "Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries" in the October 2026 file; it dates from 2003. The physician fee schedule lists A9516 with status C (contractor-priced: the MAC sets RVUs and payment case by case), so the PFS carries no national amount for it. Its 2026 Q4 MUEs per date of service: practitioner 4 (MAI 3, Prescribing Information); hospital outpatient 4 (MAI 3, Prescribing Information). In the NCCI PTP files v323r0 A9516 appears in 35 practitioner pairs as column 2 and 0 as column 1 (most often with 0868T, 38792, 78015), and in 35 hospital outpatient pairs as column 2 and 0 as column 1. No current LCD or billing article lists A9516; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage). OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS I1E (standard imaging - nuclear medicine); pricing indicator 57; type of service 4 (diagnostic radiology). 1 other active code opens with "Iodine i-123 sodium iodide"; related codes: A9509, A9512, A9520, A9528.

A9516 descriptor and code status

The October 2026 HCPCS Level II file describes A9516 as “Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries”. It sits in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), listed with the other A codes.

HCPCS file attributes of A9516
FieldValue
Short descriptorIodine i-123 sod iodide mic
Added to HCPCS2003-01-01
Last actionN (no maintenance), effective 2008-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator57: other contractor-priced
BETOS categoryI1E: standard imaging - nuclear medicine
Type of service4: diagnostic radiology

Medicare payment for A9516

The physician fee schedule lists A9516 with status C (contractor-priced: the MAC sets RVUs and payment case by case), so the PFS carries no national amount for it. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status C: contractor-priced: the MAC sets RVUs and payment case by case. Global period XXX (global surgery concept does not apply); PC/TC indicator 0 (physician service; the professional/technical split does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Ambulatory surgical center (Addendum BB)

Payment indicator N1 (Packaged service/item; no separate payment made).

Medically Unlikely Edits for A9516

Its 2026 Q4 MUEs per date of service: practitioner 4 (MAI 3, Prescribing Information); hospital outpatient 4 (MAI 3, Prescribing Information). The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for A9516 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services43 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital43 Date of Service Edit: ClinicalPrescribing Information

The MUE lookup for A9516 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, A9516 is the column-2 (bundled) code in 35 active pairs, 9% of which allow a modifier and the column-1 code in 0; 12 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.

Column-1 codes most often paired with A9516 (practitioner)
Column-1 codePairs
0868T (CPT; descriptor licensed by AMA)1
38792 (CPT; descriptor licensed by AMA)1
78015 (CPT; descriptor licensed by AMA)1
78016 (CPT; descriptor licensed by AMA)1
78018 (CPT; descriptor licensed by AMA)1
78195 (CPT; descriptor licensed by AMA)1
78215 (CPT; descriptor licensed by AMA)1
78226 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, A9516 is the column-2 (bundled) code in 35 active pairs, 9% of which allow a modifier and the column-1 code in 0; 12 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Misuse of Column Two code with Column One code.

Column-1 codes most often paired with A9516 (hospital outpatient)
Column-1 codePairs
0868T (CPT; descriptor licensed by AMA)1
38792 (CPT; descriptor licensed by AMA)1
78015 (CPT; descriptor licensed by AMA)1
78016 (CPT; descriptor licensed by AMA)1
78018 (CPT; descriptor licensed by AMA)1
78195 (CPT; descriptor licensed by AMA)1
78215 (CPT; descriptor licensed by AMA)1
78226 (CPT; descriptor licensed by AMA)1

A9516 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check A9516 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A9516

No current LCD or billing and coding article lists A9516. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Denials to expect on A9516

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of A9516 exceed the practitioner MUE of 4 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for A9516 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for A9516 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS A9516

What does HCPCS code A9516 describe?

"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries" (short descriptor "Iodine i-123 sod iodide mic"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 2003-01-01; last action N (no maintenance) effective 2008-01-01.

Is A9516 a CPT code?

No. A9516 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.

What does Medicare pay for A9516?

The physician fee schedule lists A9516 with status C (contractor-priced: the MAC sets RVUs and payment case by case), so the PFS carries no national amount for it.

How many units of A9516 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 4 (MAI 3, Prescribing Information); hospital outpatient 4 (MAI 3, Prescribing Information). For the practitioner MUE (MAI 3), units above 4 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover A9516?

No current LCD or billing article lists A9516; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.