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HCPCS A9597 · Level II · A code

A9597: Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, 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 A9597

Medicare payment
no PFS amount
PFS status X
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
MUE
none published
no MUE in the 2026 Q4 tables
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 2

TL;DR

A9597 is a Level II code from the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), in use since 2017: "Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified". The physician fee schedule lists A9597 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it. 2 billing and coding articles list A9597 across 5 states plus DC and 2 territories: A53134, A59049. 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 "Positron emission tomography radiopharmaceutical"; related codes: A9598, A9562, A9561, A9560.

A9597 descriptor and code status

The October 2026 HCPCS Level II file describes A9597 as “Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified”. 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 A9597
FieldValue
Short descriptorPet, dx, for tumor id, noc
Added to HCPCS2017-01-01
Last actionN (no maintenance), effective 2017-01-01
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 A9597

The physician fee schedule lists A9597 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 A9597

CMS publishes no MUE for A9597 in the 2026 Q4 practitioner, facility or DME supplier tables. Some MUE values are confidential and applied without publication, so unit limits can still deny; document the quantity furnished on every claim.

The MUE lookup for A9597 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists A9597 in v323r0.

A9597 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 A9597 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A9597

0 active Local Coverage Determinations and 2 billing and coding articles list A9597. 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 A9597
ArticleTitleContractor(s)Related LCD
A53134Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic ConditionsNovitas Solutions, Inc.—
A59049Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic ConditionsFirst Coast Service Options, Inc.—

Denials to expect on A9597

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists A9597

CARC 151 · N362

units exceed what the payer considers medically likely for one 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 A9597 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for A9597 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 A9597

What does HCPCS code A9597 describe?

"Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified" (short descriptor "Pet, dx, for tumor id, noc"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 2017-01-01.

Is A9597 a CPT code?

No. A9597 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "A9597 CPT code" mean this Level II code.

What does Medicare pay for A9597?

The physician fee schedule lists A9597 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it.

Does Medicare cover A9597?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 2 billing and coding articles list A9597 across 5 states plus DC and 2 territories: A53134, A59049.

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.