A9538 HCPCS code: Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries
A9538 is the HCPCS Level II code for technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries. In 2024 Medicare paid an average of $47.10 per service for A9538 across 2,337 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 1 per day on outpatient hospital claims. Medicare volume rose 28% from 2022 to 2024 (1,831 to 2,337 services). In 2024, about 510 clinicians billed Medicare for A9538 for 2,321 beneficiaries; California, New York, Florida accounted for 53% 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 | 2006-01-01 |
| Last action effective | 2006-01-01 |
Who bills A9538 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 510 |
| Medicare beneficiaries | 2,321 |
| States with claims | 27 |
| Share of services in top 3 states (California, New York, Florida) | 53% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A9538, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,831 | 1,815 | $52.90 | $42.16 |
| 2023 | 2,521 | 2,513 | $52.36 | $41.69 |
| 2024 | 2,337 | 2,321 | $59.27 | $47.10 |
States with the most A9538 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 571 | $54.51 |
| New York | 360 | $22.17 |
| Florida | 288 | $61.57 |
| New Jersey | 164 | $62.49 |
| Washington | 93 | $54.33 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Code Descriptor / CPT Instruction |
| practitioner claims | 1 | Code Descriptor / CPT Instruction |
Medicare policy articles for this code
- 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 (219 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 | 2 |
| I20.1 | Angina pectoris with documented spasm | 2 |
| I20.81 | Angina pectoris with coronary microvascular dysfunction | 2 |
| I20.89 | Other forms of angina pectoris | 2 |
| I20.9 | Angina pectoris, unspecified | 2 |
| I21.01 | ST elevation (STEMI) myocardial infarction involving left main coronary artery | 2 |
| I21.02 | ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery | 2 |
| I21.09 | ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall | 2 |
| I21.11 | ST elevation (STEMI) myocardial infarction involving right coronary artery | 2 |
| I21.19 | ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall | 2 |
Showing 10 of 219. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for A9538
- 2006-01-01: A9538 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 A9538?
A9538 is the HCPCS Level II code for technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries. Short descriptor: "Tc99m pyrophosphate".
How much does Medicare pay for A9538?
In 2024, the average Medicare payment was $47.10 per service (average allowed $59.27).
Does Medicare cover A9538?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for A9538?
Medicare policy articles that cite A9538 list 219 covered ICD-10-CM diagnosis codes across 2 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 A9538 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
- 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
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Next steps
- Run a reimbursement report for a device billed under A9538
- Watch A9538 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A9538
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.