A9603 HCPCS code: Injection, pafolacianine, 0.1 mg
A9603 is the HCPCS Level II code for injection, pafolacianine, 0.1 mg. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 64 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 | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | I1E |
| Added | 2023-10-01 |
| Last action effective | 2023-10-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 64 | CMS Policy |
| practitioner claims | 64 | CMS Policy |
What changed for A9603
- 2023-10-01: A9603 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 A9603?
A9603 is the HCPCS Level II code for injection, pafolacianine, 0.1 mg. Short descriptor: "Inj, pafolacianine, 0.1 mg".
Does Medicare cover A9603?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of A9603 can be billed per day?
64 on outpatient hospital claims; 64 on practitioner claims (NCCI medically unlikely edits).
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Next steps
- Run a reimbursement report for a device billed under A9603
- Watch A9603 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A9603
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.