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HCPCS A9520 · Level II · A code

A9520: Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries, 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); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 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; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for A9520

Medicare payment
no PFS amount
PFS status X
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 1

TL;DR

CMS describes HCPCS A9520, added in 2014, as "Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries". The physician fee schedule lists A9520 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it. MUE limits for A9520: practitioner 1 (MAI 3, Clinical: Society Comment); hospital outpatient 1 (MAI 3, Clinical: Society Comment). 1 active LCD and 1 billing and coding article list A9520 across 5 states: L33560 (Cardiovascular Nuclear Medicine), A56743. 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). Nearby codes: A9516, A9512, A9528, A9503.

A9520 descriptor and code status

The October 2026 HCPCS Level II file describes A9520 as “Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries”. It sits in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), listed with the other A codes. Although searches often call it the "A9520 CPT code", A9520 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of A9520
FieldValue
Short descriptorTc99 tilmanocept diag 0.5mci
Added to HCPCS2014-01-01
Last actionN (no maintenance), effective 2016-01-01
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 A9520

The physician fee schedule lists A9520 with status X (statutory exclusion: not a physician service under the fee schedule), 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 X: statutory exclusion: not a physician service under the fee schedule. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept 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 A9520

MUE limits for A9520: practitioner 1 (MAI 3, Clinical: Society Comment); hospital outpatient 1 (MAI 3, Clinical: Society Comment). 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 A9520 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalClinical: Society Comment
Facility outpatient hospital13 Date of Service Edit: ClinicalClinical: Society Comment

The MUE lookup for A9520 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists A9520 in v323r0.

A9520 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 A9520 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A9520

1 active Local Coverage Determination and 1 billing and coding article list A9520. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing A9520
ArticleTitleContractor(s)Related LCD
A56743Billing and Coding: Cardiovascular Nuclear MedicineWellpoint FederalL33560

Denials to expect on A9520

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists A9520

CARC 151 · N362

units of A9520 exceed the practitioner MUE of 1 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 A9520 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for A9520 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 A9520

What does HCPCS code A9520 describe?

"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries" (short descriptor "Tc99 tilmanocept diag 0.5mci"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 2014-01-01; last action N (no maintenance) effective 2016-01-01.

Is A9520 a CPT code?

No: CMS maintains A9520 in HCPCS Level II, while the AMA maintains CPT. People do search "A9520 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for A9520?

The physician fee schedule lists A9520 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it.

How many units of A9520 can be billed per day?

MUE limits for A9520: practitioner 1 (MAI 3, Clinical: Society Comment); hospital outpatient 1 (MAI 3, Clinical: Society Comment). For the practitioner MUE (MAI 3), units above 1 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover A9520?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 active LCD and 1 billing and coding article list A9520 across 5 states: L33560 (Cardiovascular Nuclear Medicine), A56743.

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.