A9501 HCPCS code: Technetium tc-99m teboroxime, diagnostic, per study dose
A9501 is the HCPCS Level II code for technetium tc-99m teboroxime, diagnostic, per study dose. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on outpatient hospital claims.
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 57 |
| BETOS category | I1E |
| Added | 2008-01-01 |
| Last action effective | 2008-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Clinical: Data |
| practitioner claims | 1 | Clinical: Data |
Medicare policy articles for this code
- 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))
- A56494: Billing and Coding: Cardiovascular Nuclear Medicine (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A56743: Billing and Coding: Cardiovascular Nuclear Medicine (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (695 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| I20.0 | Unstable angina | 3 |
| I20.1 | Angina pectoris with documented spasm | 3 |
| I20.81 | Angina pectoris with coronary microvascular dysfunction | 3 |
| I20.89 | Other forms of angina pectoris | 3 |
| I20.9 | Angina pectoris, unspecified | 3 |
| I21.01 | ST elevation (STEMI) myocardial infarction involving left main coronary artery | 3 |
| I21.02 | ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery | 3 |
| I21.09 | ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall | 3 |
| I21.11 | ST elevation (STEMI) myocardial infarction involving right coronary artery | 3 |
| I21.19 | ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall | 3 |
Showing 10 of 695. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for A9501
- 2008-01-01: A9501 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 A9501?
A9501 is the HCPCS Level II code for technetium tc-99m teboroxime, diagnostic, per study dose. Short descriptor: "Technetium tc-99m teboroxime".
Does Medicare cover A9501?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for A9501?
Medicare policy articles that cite A9501 list 695 covered ICD-10-CM diagnosis codes across 4 articles. The most cited include I20.0 (Unstable angina), I20.1 (Angina pectoris with documented spasm), I20.81 (Angina pectoris with coronary microvascular dysfunction). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of A9501 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related A95 codes
- A9500 — Technetium tc-99m sestamibi, diagnostic, per study dose
- A9502 — Technetium tc-99m tetrofosmin, diagnostic, per study dose
- A9503 — Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries
- A9504 — Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries
- A9505 — Thallium tl-201 thallous chloride, diagnostic, per millicurie
- A9506 — Graphite crucible for preparation of technetium tc 99m-labeled carbon aerosol, one crucible
- A9507 — Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries
- A9508 — Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie
- A9509 — Iodine i-123 sodium iodide, diagnostic, per millicurie
- A9510 — Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries
- A9512 — Technetium tc-99m pertechnetate, diagnostic, per millicurie
- A9513 — Lutetium lu 177, dotatate, therapeutic, 1 millicurie
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 A9501
- Watch A9501 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A9501
Sources: CMS HCPCS Level II release October 2026; 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.