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HCPCS A9579 · Level II · Part B drug

HCPCS A9579: Injection, gadolinium-based magnetic resonance contrast agent, not otherwise

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 A9579

Billing unit
1 ML
Gad-base mr contrast nos,1ml
ASP payment limit
$1.435
October 2026; +0.0% vs July 2026
Practitioner MUE
100
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS A9579 is the Level II code for Injection, gadolinium-based magnetic resonance contrast agent, not otherwise, billed per 1 ML. The Medicare Part B ASP payment limit for October 2026 is $1.435 per billing unit, up 0.0% from July 2026. The practitioner MUE allows up to 100 units per date of service (MAI 3). Under OPPS it carries status indicator N. Diagnostic agents are usually packaged under OPPS (status N) in the hospital outpatient setting, so separate payment applies mainly in the physician office under Part B. The ASP crosswalk maps 18 NDCs to it, sold as Prohance, Omniscan, Ambelvist by Bracco Diagnostics Inc., GE Healthcare Inc., Bayer HealthCare Pharmaceuticals Inc.. No current Billing and Coding Article lists A9579, 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 A9579 at $1.435 per 1 ML for October 2026, derived from manufacturer average sales price plus 6%, compared with $1.435 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for A9579
QuarterPayment limitPerCoinsurance
October 2026$1.4351 ML20%
July 2026$1.4351 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 18 NDCs from 4 labelers to A9579. Report the NDC in the claim's drug segment and bill the number of A9579 units that equals the quantity administered divided by 1 ML; the last column gives units per full package.

NDCs that crosswalk to A9579
NDCDrug nameLabelerPackage sizeBilling units / package
00270-1111-01ProhanceBracco Diagnostics Inc.10 × 550
00270-1111-02ProhanceBracco Diagnostics Inc.15 × 575
00270-1111-03ProhanceBracco Diagnostics Inc.20 × 5100
00270-1111-04ProhanceBracco Diagnostics Inc.5 × 525
00270-1111-85ProhanceBracco Diagnostics Inc.100 × 5500
00407-0690-05OmniscanGE Healthcare Inc.5 × 1050
00407-0690-10OmniscanGE Healthcare Inc.10 × 10100
00407-0690-12OmniscanGE Healthcare Inc.10 × 10100
00407-0690-15OmniscanGE Healthcare Inc.15 × 10150
00407-0690-17OmniscanGE Healthcare Inc.15 × 10150
00407-0690-20OmniscanGE Healthcare Inc.20 × 10200
00407-0690-22OmniscanGE Healthcare Inc.20 × 10200
00407-0690-70OmniscanGE Healthcare Inc.100 × 101000
50419-0323-11AmbelvistBayer HealthCare Pharmaceuticals Inc.10 × 10100
70436-0121-31GadoteridolSlate Run Pharmaceuticals5 × 525
70436-0121-33GadoteridolSlate Run Pharmaceuticals10 × 550
70436-0121-34GadoteridolSlate Run Pharmaceuticals15 × 575
70436-0121-35GadoteridolSlate Run Pharmaceuticals20 × 5100

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for A9579. For practitioners the limit is 100 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 A9579 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services1003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital1003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists A9579 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.

A9579 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 A9579 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, A9579 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for A9579 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 A9579 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 A9579

What does HCPCS code A9579 describe?

A9579 is defined by CMS as "Injection, gadolinium-based magnetic resonance contrast agent, not otherwise". Each billing unit represents 1 ML, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for A9579 in October 2026?

The ASP-based payment limit is $1.435 per 1 ML, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $1.435.

How many units of A9579 can be billed per day?

The practitioner Medically Unlikely Edit is 100 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 "Prescribing Information" as the rationale.

Which NDCs map to A9579?

The October 2026 ASP crosswalk lists 18 NDCs from 4 labelers: Prohance (Bracco Diagnostics Inc.); Omniscan (GE Healthcare Inc.); Ambelvist (Bayer HealthCare Pharmaceuticals Inc.); Gadoteridol (Slate Run Pharmaceuticals). For example NDC 00270-1111-01 is a 10 package equal to 50 billing units. The crosswalk's billing-units-per-package figure converts each package into A9579 units.

Does A9579 have NCCI bundling edits?

No active practitioner PTP pairs list A9579 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.