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HCPCS A9575 · Level II · Part B drug

HCPCS A9575: Injection, gadoterate meglumine, 0.1 ml

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for A9575

Billing unit
0.1 ML
Inj gadoterate meglumi 0.1ml
ASP payment limit
$0.105
October 2026; +16.7% vs July 2026
Practitioner MUE
300
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS A9575 is the Level II code for Injection, gadoterate meglumine, 0.1 ml, billed per 0.1 ML. The Medicare Part B ASP payment limit for October 2026 is $0.105 per billing unit, up 16.7% from July 2026. The practitioner MUE allows up to 300 units per date of service (MAI 3). Under OPPS it carries status indicator N. A9575 is billed in units of 0.1 ML; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. The ASP crosswalk maps 30 NDCs to it, sold as Clariscan, Gadoterate Meglumine, Dotarem by GE Healthcare Inc., FreseniUS Kabi USA, LLC, Guerbet LLC. No current Billing and Coding Article lists A9575, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for A9575 at $0.105 per 0.1 ML for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.09 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for A9575
QuarterPayment limitPerCoinsurance
October 2026$0.1050.1 ML20%
July 2026$0.090.1 ML—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 30 NDCs from 4 labelers to A9575. Report the NDC in the claim's drug segment and bill the number of A9575 units that equals the quantity administered divided by 0.1 ML; the last column gives units per full package.

NDCs that crosswalk to A9575
NDCDrug nameLabelerPackage sizeBilling units / package
00407-2943-01ClariscanGE Healthcare Inc.10 × 101000
00407-2943-02ClariscanGE Healthcare Inc.15 × 101500
00407-2943-05ClariscanGE Healthcare Inc.20 × 102000
00407-2943-06Gadoterate MeglumineGE Healthcare Inc.5 × 10500
00407-2943-12Gadoterate MeglumineGE Healthcare Inc.10 × 101000
00407-2943-17Gadoterate MeglumineGE Healthcare Inc.15 × 101500
00407-2943-22Gadoterate MeglumineGE Healthcare Inc.20 × 102000
00407-2943-70Gadoterate MeglumineGE Healthcare Inc.100 × 1010000
65219-0080-05Gadoterate MeglumineFreseniUS Kabi USA, LLC5 × 10500
65219-0082-10Gadoterate MeglumineFreseniUS Kabi USA, LLC10 × 101000
65219-0084-15Gadoterate MeglumineFreseniUS Kabi USA, LLC15 × 101500
65219-0086-20Gadoterate MeglumineFreseniUS Kabi USA, LLC20 × 102000
65219-0088-50Gadoterate MeglumineFreseniUS Kabi USA, LLC100 × 66000
67684-2000-00DotaremGuerbet LLC5 × 10500
67684-2000-01DotaremGuerbet LLC10 × 101000
67684-2000-05DotaremGuerbet LLC10 × 5500
67684-2000-06DotaremGuerbet LLC15 × 5750
67684-2001-00DotaremGuerbet LLC5 × 10500
67684-2001-01DotaremGuerbet LLC10 × 101000
67684-2001-02DotaremGuerbet LLC15 × 101500
67684-2001-03DotaremGuerbet LLC20 × 102000
67684-2001-04DotaremGuerbet LLC100 × 66000
67684-3001-01DotaremGuerbet LLC10 × 101000
67684-3001-02DotaremGuerbet LLC15 × 101500
67684-3001-03DotaremGuerbet LLC20 × 102000
70436-0123-31Gadoterate MeglumineSlate Run Pharmaceuticals5 × 10500
70436-0123-33Gadoterate MeglumineSlate Run Pharmaceuticals10 × 101000
70436-0123-34Gadoterate MeglumineSlate Run Pharmaceuticals15 × 101500
70436-0123-35Gadoterate MeglumineSlate Run Pharmaceuticals20 × 102000
70436-0123-56Gadoterate MeglumineSlate Run Pharmaceuticals100 × 66000

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for A9575. For practitioners the limit is 300 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for A9575 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services3003 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital3003 Date of Service Edit: ClinicalClinical: Data

NCCI edits and add-on relationships

No active practitioner PTP pair lists A9575 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

A9575 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists A9575 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, A9575 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for A9575 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks A9575 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

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Frequently asked questions — HCPCS A9575

What does HCPCS code A9575 describe?

A9575 is defined by CMS as "Injection, gadoterate meglumine, 0.1 ml". Each billing unit represents 0.1 ML, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for A9575 in October 2026?

The ASP-based payment limit is $0.105 per 0.1 ML, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.09.

How many units of A9575 can be billed per day?

The practitioner Medically Unlikely Edit is 300 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Clinical: Data" as the rationale.

Which NDCs map to A9575?

The October 2026 ASP crosswalk lists 30 NDCs from 4 labelers: Clariscan (GE Healthcare Inc.); Gadoterate Meglumine (GE Healthcare Inc.); Gadoterate Meglumine (FreseniUS Kabi USA, LLC); Dotarem (Guerbet LLC). For example NDC 00407-2943-01 is a 10 package equal to 1000 billing units. The crosswalk's billing-units-per-package figure converts each package into A9575 units.

Does A9575 have NCCI bundling edits?

No active practitioner PTP pairs list A9575 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.