HCPCS Level II › A codes A9509 Iodine i-123 sod iodide milIodine i-123 sodium iodide, diagnostic, per millicurie
Medicare coverage: Carrier judgment Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 5 units per day (clinical), rationale: Clinical: Society Comment Outpatient hospital: max 5 units per day (clinical), rationale: Clinical: Society Comment Medicare pricing for A9509 Physician Fee Schedule (CY 2026, RVU26D) Status C: contractor-priced by the MAC.
Payer policies and prior authorization for A9509 Payer coverage policies that name A9509 A9509 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Tumor Scintigraphy (0168) not covered Mar 27, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in IN.
AZ: $204.90 (outpatient_hospital), effective Jan 1, 2025 KY: $0.00 (asc), effective Jan 1, 2026 OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $204.90 (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.