A9516 HCPCS code: Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries
A9516 is the HCPCS Level II code for iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries. In 2024 Medicare paid an average of $56.23 per service for A9516 across 2,263 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 4 per day on outpatient hospital claims. Medicare volume fell 11% from 2022 to 2024 (2,543 to 2,263 services). In 2024, about 380 clinicians billed Medicare for A9516 for 1,214 beneficiaries; Florida, California, New York accounted for 56% of services.
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 | 2003-01-01 |
| Last action effective | 2008-01-01 |
Who bills A9516 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 380 |
| Medicare beneficiaries | 1,214 |
| States with claims | 18 |
| Share of services in top 3 states (Florida, California, New York) | 56% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A9516, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 2,543 | 1,358 | $88.84 | $70.66 |
| 2023 | 2,273 | 1,228 | $81.46 | $64.61 |
| 2024 | 2,263 | 1,214 | $71.83 | $56.23 |
States with the most A9516 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 489 | $32.86 |
| California | 412 | $58.66 |
| New York | 238 | $97.36 |
| Arizona | 221 | $29.98 |
| Nevada | 106 | $28.27 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 4 | Prescribing Information |
| practitioner claims | 4 | Prescribing Information |
What changed for A9516
- 2003-01-01: A9516 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 A9516?
A9516 is the HCPCS Level II code for iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries. Short descriptor: "Iodine i-123 sod iodide mic".
How much does Medicare pay for A9516?
In 2024, the average Medicare payment was $56.23 per service (average allowed $71.83).
Does Medicare cover A9516?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of A9516 can be billed per day?
4 on outpatient hospital claims; 4 on practitioner claims (NCCI medically unlikely edits).
Related A95 codes
- A9500 — Technetium tc-99m sestamibi, diagnostic, per study dose
- A9501 — Technetium tc-99m teboroxime, 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
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 A9516
- Watch A9516 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A9516
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.