`A9508` I131 iodobenguate, dx

Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 2 units per day (clinical), rationale: Prescribing Information
Outpatient hospital: max 2 units per day (clinical), rationale: Prescribing Information

Medicare pricing for A9508

Physician Fee Schedule (CY 2026, RVU26D)

Status C: contractor-priced by the MAC.

Payer policies and prior authorization for A9508

1 of 1 payer prior-auth lists that name A9508 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Cross and Blue Shield of Texas	Texas PA exemption (gold card), outpatient, fully insured	TX	prior auth required	Gold-card exemption available	Jul 1, 2026	BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)

Payer coverage policies that name A9508

A9508 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Tumor Scintigraphy (0168)	covered if criteria are met	Mar 27, 2026	payer document

Medicaid fee-for-service

AZ: $905.36 (asc), effective Oct 1, 2026
IN: $0.00 (professional, facility), effective Nov 10, 2017
KY: $953.01 (asc), effective Jan 1, 2026
OH: $78.75 (provider_administered_drugs), effective Sep 1, 2005
TX: $163.40 (miscellaneous_other_professionals_portable_x_ray_radiologica, Miscellaneous Other Professionals - Portable X-Ray, Radiological Lab, Physiological Lab, non-facility), effective Mar 1, 2024
VT: $724.29 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $1325.25 (physician, facility), effective Jul 1, 2026
WY: $412.52 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.

A9508 I131 iodobenguate, dx