A4641 HCPCS code: Radiopharmaceutical, diagnostic, not otherwise classified
A4641 is the HCPCS Level II code for radiopharmaceutical, diagnostic, not otherwise classified. In 2024 Medicare paid an average of $200.32 per service for A4641 across 207 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. Medicare volume fell 10% from 2022 to 2024 (231 to 207 services). In 2024, about 26 clinicians billed Medicare for A4641 for 197 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | I1E |
| Added | 1994-01-01 |
| Last action effective | 2006-01-01 |
Who bills A4641 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 26 |
| Medicare beneficiaries | 197 |
| States with claims | 4 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4641, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 231 | 205 | $154.40 | $122.74 |
| 2023 | 268 | 258 | $171.25 | $136.08 |
| 2024 | 207 | 197 | $258.50 | $200.32 |
States with the most A4641 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 116 | $184.82 |
| New York | 28 | $227.27 |
| Florida | 25 | $246.26 |
| Arizona | 11 | $135.77 |
Medicare policy articles for this code
- A52437: Billing and Coding: Sentinel Lymph Node Biopsy – Medical Policy Article (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A54880: Billing and Coding: Additional Claim Documentation Requirements for Not Otherwise Classified (NOC) Drugs and Biological Products with Specific FDA Label Indications (Palmetto GBA (MAC - Part A, MAC - Part B))
- A56476: Billing and Coding: Cardiac Radionuclide Imaging (Palmetto GBA (MAC - Part A, MAC - Part B))
- A56476: Billing and Coding: Cardiac Radionuclide Imaging (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (635 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| A18.84 | Tuberculosis of heart | 1 |
| C58 | Malignant neoplasm of placenta | 1 |
| C81.10 | Nodular sclerosis Hodgkin lymphoma, unspecified site | 1 |
| C81.11 | Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck | 1 |
| C81.12 | Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes | 1 |
| C81.13 | Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes | 1 |
| C81.14 | Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb | 1 |
| C81.15 | Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb | 1 |
| C81.16 | Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes | 1 |
| C81.17 | Nodular sclerosis Hodgkin lymphoma, spleen | 1 |
Showing 10 of 635. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for A4641
- 1994-01-01: A4641 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code A4641?
A4641 is the HCPCS Level II code for radiopharmaceutical, diagnostic, not otherwise classified. Short descriptor: "Radiopharm dx agent noc".
How much does Medicare pay for A4641?
In 2024, the average Medicare payment was $200.32 per service (average allowed $258.50).
Does Medicare cover A4641?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for A4641?
Medicare policy articles that cite A4641 list 635 covered ICD-10-CM diagnosis codes across 4 articles. The most cited include A18.84 (Tuberculosis of heart), C58 (Malignant neoplasm of placenta), C81.10 (Nodular sclerosis Hodgkin lymphoma, unspecified site). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Related A46 codes
- A4600 — Sleeve for intermittent limb compression device, replacement only, each
- A4601 — Lithium ion battery, rechargeable, for non-prosthetic use, replacement
- A4602 — Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each ($5.31–$6.33)
- A4604 — Tubing with integrated heating element for use with positive airway pressure device ($49.31–$76.79)
- A4605 — Tracheal suction catheter, closed system, each ($23.31–$27.99)
- A4606 — Oxygen probe for use with oximeter device, replacement
- A4608 — Transtracheal oxygen catheter, each ($71.44–$85.73)
- A4611 — Battery, heavy duty; replacement for patient owned ventilator
- A4612 — Battery cables; replacement for patient-owned ventilator
- A4613 — Battery charger; replacement for patient-owned ventilator
- A4614 — Peak expiratory flow rate meter, hand held ($33.89–$40.68)
- A4615 — Cannula, nasal ($1.04–$1.25)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under A4641
- Watch A4641 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4641
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.