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HCPCS A9613 · Level II · Part B drug

A9613: piflufolastat 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 A9613

Billing unit
1 millicurie
F 18 pylarify truvu, dx 1mci
OPPS payment rate
$652.52
no ASP limit; SI G, October 2026
Practitioner MUE
none published
CMS publishes no MUE for this code
OPPS status
SI G
APC 0962
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS A9613 is the Level II code for Piflufolastat f 18 (pylarify truvu), 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, $652.52 per billing unit in October 2026). Unlike most diagnostic agents, which OPPS packages into the procedure (status N), A9613 is paid separately in the hospital outpatient department (status G). No current Billing and Coding Article lists A9613, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare payment: OPPS rate (no ASP limit)

A9613 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 0962, at a national unadjusted rate of $652.52 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 A9613. Report the NDC from the product label and confirm the units conversion from the HCPCS descriptor (Piflufolastat f 18 (pylarify truvu), diagnostic, 1 millicurie).

Medically Unlikely Edits (MUE)

CMS does not publish an MUE for A9613 in the 2026 Q4 tables. Some MUE values are confidential and applied without publication, so unit limits can still deny; document the dose and the units calculation on every claim.

MUE for A9613 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 A9613 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 A9613 against another code to see whether a given pair bundles, which code is paid and whether a modifier can separate them.

A9613 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 A9613 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 October 2026 OPPS Addendum B, A9613 carries status indicator G and is assigned to APC 0962, with a published national unadjusted payment of $652.52. 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), A9613 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 $652.52 per 1 millicurie, paid only when the drug is furnished integral to a covered surgical procedure.

Common denials for A9613 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 A9613 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 A9613

What does HCPCS code A9613 describe?

A9613 is defined by CMS as "Piflufolastat f 18 (pylarify truvu), 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 A9613 a CPT code?

No. A9613 is a HCPCS Level II code, the letter-plus-four-digit set CMS maintains for drugs such as piflufolastat f 18; CPT codes are five-character codes maintained by the AMA. On a Part B claim A9613 reports the drug itself in 1 millicurie units, and the administration is billed on its own line.

What does Medicare pay for A9613 in a hospital outpatient department?

A9613 has no Part B ASP limit; the October 2026 OPPS Addendum B pays it separately under status G, APC 0962, at $652.52 per 1 millicurie, and ASC Addendum BB gives it payment indicator K2 at $652.52.

Does A9613 have NCCI bundling edits?

No active practitioner PTP pairs list A9613 as a column-1 or column-2 code in the v323r0 release.

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.