Key facts for A9561
- Medicare payment
- no PFS amount
- PFS status C
- Coverage code
- C
- carrier judgment, so the Medicare contractor decides coverage
- Practitioner MUE
- 1
- MAI 3
- NCCI PTP pairs
- 31
- 31 hospital outpatient
- LCDs and articles
- 0 / 0
TL;DR
A9561 is a Level II code from the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), in use since 2006: "Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries". The physician fee schedule lists A9561 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 1 (MAI 3, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 3, Code Descriptor / CPT Instruction). In the NCCI PTP files v323r0 A9561 appears in 30 practitioner pairs as column 2 and 1 as column 1 (most often with 0868T, 38792, 78018), and in 30 hospital outpatient pairs as column 2 and 1 as column 1. No current LCD or billing article lists A9561; 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). Nearby codes: A9560, A9562, A9555, A9552.
A9561 descriptor and code status
The October 2026 HCPCS Level II file describes A9561 as “Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries”. It sits in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), listed with the other A codes.
| Field | Value |
|---|---|
| Short descriptor | Tc99m oxidronate |
| Added to HCPCS | 2006-01-01 |
| Last action | N (no maintenance), effective 2006-01-01 |
| Coverage code | C: carrier judgment, so the Medicare contractor decides coverage |
| Pricing indicator | 57: other contractor-priced |
| BETOS category | I1E: standard imaging - nuclear medicine |
| Type of service | 4: diagnostic radiology |
Medicare payment for A9561
The physician fee schedule lists A9561 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 A9561
Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 3, Code Descriptor / CPT Instruction). The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.
| Setting | MUE (units/DOS) | MAI | CMS rationale |
|---|---|---|---|
| Practitioner services | 1 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
| Facility outpatient hospital | 1 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
The MUE lookup for A9561 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
In the practitioner PTP file v323r0, A9561 is the column-2 (bundled) code in 30 active pairs, 3% of which allow a modifier and the column-1 code in 1 (0% modifier-allowed); 14 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 code | Pairs |
|---|---|
| 0868T (CPT; descriptor licensed by AMA) | 1 |
| 38792 (CPT; descriptor licensed by AMA) | 1 |
| 78018 (CPT; descriptor licensed by AMA) | 1 |
| 78102 (CPT; descriptor licensed by AMA) | 1 |
| 78104 (CPT; descriptor licensed by AMA) | 1 |
| 78195 (CPT; descriptor licensed by AMA) | 1 |
| 78202 (CPT; descriptor licensed by AMA) | 1 |
| 78215 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| A9512 Tc99m pertechnetate | 1 |
In the hospital outpatient PTP file v323r0, A9561 is the column-2 (bundled) code in 30 active pairs, 3% of which allow a modifier and the column-1 code in 1 (0% modifier-allowed); 14 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 code | Pairs |
|---|---|
| 0868T (CPT; descriptor licensed by AMA) | 1 |
| 38792 (CPT; descriptor licensed by AMA) | 1 |
| 78018 (CPT; descriptor licensed by AMA) | 1 |
| 78102 (CPT; descriptor licensed by AMA) | 1 |
| 78104 (CPT; descriptor licensed by AMA) | 1 |
| 78195 (CPT; descriptor licensed by AMA) | 1 |
| 78202 (CPT; descriptor licensed by AMA) | 1 |
| 78215 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| A9512 Tc99m pertechnetate | 1 |
A9561 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 A9561 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for A9561
No current LCD or billing and coding article lists A9561. 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 A9561
the modifier reported is inconsistent with the code
the claim lacks the description, invoice or pricing detail a contractor-priced code needs
Where QuickIntell fits for A9561 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for A9561 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.
Frequently asked questions: HCPCS A9561
What does HCPCS code A9561 describe?
"Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries" (short descriptor "Tc99m oxidronate"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 2006-01-01.
Is A9561 a CPT code?
No. A9561 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.
What does Medicare pay for A9561?
The physician fee schedule lists A9561 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 A9561 can be billed per day?
Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 3, Code Descriptor / CPT Instruction). 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 A9561?
No current LCD or billing article lists A9561; 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.
- HCPCS Level II alpha-numeric file, October 2026Version October 2026 · effective 2026-10-01 · file HCPC2026_OCT_ANWEB_09232026.txtSHA-256 c25240c63108756d…
- Medicare PFS national relative value file RVU26D (non-QPP), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_nonQPP.csvSHA-256 4d0d3f19bd954ffc…
- Medicare PFS national relative value file RVU26D (qualifying APM participants), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_QPP.csvSHA-256 59d3734704853936…
- OPPS Addendum B, October 2026Version October 2026 · effective 2026-10-01 · file 508-compliant-version-2026_October_Web_Addendum_B.09.28.26.csvSHA-256 6ad7393a318bf1b9…
- Integrated Outpatient Code Editor v27.3 data tables: status and payment indicatorsVersion I/OCE v27.3 (October 2026) · effective 2026-10-01 · file Data_Status_Indicator.txtSHA-256 78f119ef0a435351…
- ASC Addendum BB (covered ancillary services), October 2026Version October 2026 · effective 2026-10-01 · file Oct 2026 ASC BB.txtSHA-256 63cdd7c72aba7a25…
- NCCI MUE table, practitioner services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_PractitionerServices_Eff_10-01-2026.csvSHA-256 ef038efaf902b7bd…
- NCCI MUE table, facility services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_OutpatientHospitalServices_Eff_10-01-2026.csvSHA-256 3af9f4e99cc587e2…
- NCCI MUE table, dme services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_DMESupplierServices_Eff_10-01-2026.csvSHA-256 6fa4fbba852f7b74…
- NCCI PTP edits, practitioner, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccipra-v323r0-f1.TXTSHA-256 7793c0b6686c1e22…
- NCCI PTP edits, hospital outpatient, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccioph-v323r0-f1.txtSHA-256 063f41b91ef9faa2…
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.