A9597 HCPCS code: Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified
A9597 is the HCPCS Level II code for positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified. In 2023 Medicare paid an average of $1,352.66 per service for A9597 across 275 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. Medicare volume fell 94% from 2022 to 2023 (4,309 to 275 services). In 2023, about 28 clinicians billed Medicare for A9597 for 91 beneficiaries.
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 | 2017-01-01 |
| Last action effective | 2017-01-01 |
Who bills A9597 (2023)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 28 |
| Medicare beneficiaries | 91 |
| States with claims | 4 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A9597, 2022–2023
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 4,309 | 860 | $900.70 | $718.80 |
| 2023 | 275 | 91 | $1,698.54 | $1,352.66 |
States with the most A9597 services (2023)
| State | Services | Avg. paid |
|---|---|---|
| New York | 136 | $426.09 |
| Texas | 22 | $3,855.91 |
| Oklahoma | 19 | $5,158.72 |
| Florida | 18 | $3,660.56 |
Medicare policy articles for this code
- A53134: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B))
- A59049: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B))
Covered diagnoses (55 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| F03.90 | Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | 2 |
| F03.911 | Unspecified dementia, unspecified severity, with agitation | 2 |
| F03.918 | Unspecified dementia, unspecified severity, with other behavioral disturbance | 2 |
| F03.92 | Unspecified dementia, unspecified severity, with psychotic disturbance | 2 |
| F03.93 | Unspecified dementia, unspecified severity, with mood disturbance | 2 |
| F03.94 | Unspecified dementia, unspecified severity, with anxiety | 2 |
| F03.A0 | Unspecified dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | 2 |
| F03.A11 | Unspecified dementia, mild, with agitation | 2 |
| F03.A18 | Unspecified dementia, mild, with other behavioral disturbance | 2 |
| F03.A2 | Unspecified dementia, mild, with psychotic disturbance | 2 |
Showing 10 of 55. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for A9597
- 2017-01-01: A9597 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 A9597?
A9597 is the HCPCS Level II code for positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified. Short descriptor: "Pet, dx, for tumor id, noc".
How much does Medicare pay for A9597?
In 2023, the average Medicare payment was $1,352.66 per service (average allowed $1,698.54).
Does Medicare cover A9597?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for A9597?
Medicare policy articles that cite A9597 list 55 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include F03.90 (Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety), F03.911 (Unspecified dementia, unspecified severity, with agitation), F03.918 (Unspecified dementia, unspecified severity, with other behavioral disturbance). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
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 A9597
- Watch A9597 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A9597
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.