HCPCS Level II › A codes A9502 Tc99m tetrofosminTechnetium tc-99m tetrofosmin, diagnostic, per study dose
Medicare coverage: Carrier judgment Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 3 units per day (clinical), rationale: Clinical: Society Comment Outpatient hospital: max 3 units per day (clinical), rationale: Clinical: Society Comment Medicare pricing for A9502 Physician Fee Schedule (CY 2026, RVU26D) Status C: contractor-priced by the MAC.
Payer policies and prior authorization for A9502 0 of 1 payer prior-auth lists that name A9502 require prior authorization or set conditions.
Payer coverage policies that name A9502 A9502 appears in 2 coverage policies from Aetna, Blue Shield of California.
Payer Policy Role in policy Reviewed Document Aetna Transthyretin-Mediated (ATTR) Amyloidosis (0939) listed, no stance (range A9500-A9504) Aug 10, 2026 payer document Blue Shield of California Scintimammography and Gamma Imaging of the Breast and Axilla (6.01.18) listed, no stance payer document
Medicaid fee-for-service AZ: $85.27 (outpatient_hospital), effective Oct 1, 2024 FL: $170.21 (radiology, non-facility), effective Jan 1, 2026 IN: $0.00 (professional, facility), effective Jan 1, 1998 KY: $0.00 (asc), effective Jan 1, 2026 LA: $94.80 (professional), effective Feb 1, 2013 NE: $91.07 (injectables), effective Jul 1, 2026 OH: $78.75 (provider_administered_drugs), effective Sep 1, 2005 OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026 TX: $82.84 (miscellaneous_other_professionals_portable_x_ray_radiologica, Miscellaneous Other Professionals - Portable X-Ray, Radiological Lab, Physiological Lab, non-facility), effective Jan 1, 2018 VA: $106.04 (medical), effective Jan 1, 2001 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $97.21 (physician, facility), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.