`A9528` Iodine i-131 iodide cap, dx

Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie

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

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 10 units per day (clinical), rationale: Clinical: Data
Outpatient hospital: max 10 units per day (clinical), rationale: Clinical: Data

Medicare pricing for A9528

Physician Fee Schedule (CY 2026, RVU26D)

Status C: contractor-priced by the MAC.

Payer policies and prior authorization for A9528

2 of 2 payer prior-auth lists that name A9528 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Cross and Blue Shield of Illinois	Blue Cross Community Health Plans (BCCHP), Illinois Medicaid	IL	prior auth required	Carelon-managed	Aug 1, 2025	Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026
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 A9528

A9528 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Transthyretin-Mediated (ATTR) Amyloidosis (0939)	listed, no stance (range A9510-A9568)	Aug 10, 2026	payer document

Recent prior-auth changes

Nov 1, 2025: PA added, Blue Cross and Blue Shield of Illinois

Medicaid fee-for-service

Prior authorization required or conditional in IN.

AZ: $0.01 (outpatient_hospital), effective Apr 1, 2025
KY: $0.00 (asc), effective Jan 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 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.

A9528 Iodine i-131 iodide cap, dx