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HCPCS A9611 · Level II · Part B drug

A9611: flurpiridaz f 18, HCPCS Level II drug code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: OPPS Addendum B: October 2026 (effective October 1, 2026); OPPS NDC-HCPCS crosswalk: October 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); ASC Addendum BB (covered ancillary services): October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update).

Key facts for A9611

Billing unit
1 millicurie
Flurpiridaz f18, diag, 1 mci
OPPS payment rate
$530.00
no ASP limit; SI G, October 2026
Practitioner MUE
13
MAI 3
OPPS status
SI G
APC 2065
NCCI exposure
no PTP pairs
Coverage articles
1
4 states

TL;DR

HCPCS A9611 is the Level II code for Flurpiridaz f 18, diagnostic, 1 millicurie, billed per 1 millicurie. CMS publishes no ASP payment limit for it; hospital outpatient departments are paid separately under OPPS (status indicator G, $530.00 per billing unit in October 2026). The practitioner MUE allows up to 13 units per date of service (MAI 3). Unlike most diagnostic agents, which OPPS packages into the procedure (status N), A9611 is paid separately in the hospital outpatient department (status G). 1 Medicare coverage article lists the code across 4 states, including A56476.

Medicare payment: OPPS rate (no ASP limit)

A9611 does not appear in the October 2026 Part B ASP payment limit file. CMS pays it separately to hospital outpatient departments under OPPS with status indicator G in APC 2065, at a national unadjusted rate of $530.00 per 1 millicurie. Status G is drug pass-through payment, which lasts a limited number of years. In a physician office the Medicare contractor prices the drug, often from invoice; commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 OPPS crosswalk lists no NDC for A9611. Report the NDC from the product label and confirm the units conversion from the HCPCS descriptor (Flurpiridaz f 18, diagnostic, 1 millicurie).

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for A9611. For practitioners the limit is 13 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 A9611 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services133 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital133 Date of Service Edit: ClinicalPrescribing Information

MUE for A9611 in every setting opens the lookup with this code filled in, next to any other code on the same claim.

NCCI edits and add-on relationships

No active practitioner PTP pair lists A9611 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.

The counts above are exposure, not answers for a specific claim. Check A9611 against another code to see whether a given pair bundles, which code is paid and whether a modifier can separate them.

A9611 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

1 current Medicare Administrative Contractor article lists A9611 in their HCPCS tables, covering 4 states. Each article carries the covered and non-covered ICD-10 codes that medical-necessity denials (CARC 50) are adjudicated against.

Billing and Coding Articles listing A9611
ArticleTitleContractor(s)StatesRelated LCD
A56476Billing and Coding: Cardiac Radionuclide ImagingPalmetto GBANC SC VA WVL33457

Local coverage policies that list A9611

1 active Local Coverage Determination lists A9611 in the policy or in its billing and coding article. Each applies only in its contractor's jurisdiction; check the one for the state where the drug is administered.

Hospital outpatient (OPPS) status

In the October 2026 OPPS Addendum B, A9611 carries status indicator G and is assigned to APC 2065, with a published national unadjusted payment of $530.00. Status G marks pass-through drug payment, which is time-limited.

Ambulatory surgical center (ASC) payment

In the October 2026 ASC Addendum BB (covered ancillary services), A9611 carries payment indicator K2, which CMS defines as "Drugs, biologicals, and radiopharmaceuticals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate". The national ASC payment is $530.00 per 1 millicurie, paid only when the drug is furnished integral to a covered surgical procedure.

Common denials for A9611 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 A9611 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current OPPS NDC-HCPCS 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 A9611

What does HCPCS code A9611 describe?

A9611 is defined by CMS as "Flurpiridaz f 18, diagnostic, 1 millicurie". Each billing unit represents 1 millicurie, so the units reported on the claim must equal the dose administered divided by that unit.

Is A9611 a CPT code?

No. A9611 is a HCPCS Level II code, the letter-plus-four-digit set CMS maintains for drugs such as flurpiridaz f 18; CPT codes are five-character codes maintained by the AMA. On a Part B claim A9611 reports the drug itself in 1 millicurie units, and the administration is billed on its own line.

What does Medicare pay for A9611 in a hospital outpatient department?

A9611 has no Part B ASP limit; the October 2026 OPPS Addendum B pays it separately under status G, APC 2065, at $530.00 per 1 millicurie, and ASC Addendum BB gives it payment indicator K2 at $530.00.

How many units of A9611 can be billed per day?

The practitioner Medically Unlikely Edit is 13 units per date of service with adjudication indicator 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.

Does A9611 have NCCI bundling edits?

No active practitioner PTP pairs list A9611 as a column-1 or column-2 code in the v323r0 release.

Which Medicare coverage articles mention A9611?

1 current Billing and Coding Article in the Medicare Coverage Database lists A9611, covering 4 states: A56476 (Billing and Coding: Cardiac Radionuclide Imaging).

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 Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B, ASC Addendum BB and the Medicare Coverage Database. Payment limits and rates 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.

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.