`A9538` Tc99m pyrophosphate

Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries

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

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 1 units per day (clinical), rationale: Code Descriptor / CPT Instruction
Outpatient hospital: max 1 units per day (clinical), rationale: Code Descriptor / CPT Instruction

Medicare pricing for A9538

Physician Fee Schedule (CY 2026, RVU26D)

Status C: contractor-priced by the MAC.

Payer policies and prior authorization for A9538

0 of 1 payer prior-auth lists that name A9538 require prior authorization or set conditions.

Payer coverage policies that name A9538

A9538 appears in 2 coverage policies from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Myopathy: Selected Tests (0862)	not covered	Dec 24, 2025	payer document
Aetna	Transthyretin-Mediated (ATTR) Amyloidosis (0939)	listed, no stance (range A9510-A9568)	Aug 10, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

AZ: $64.05 (outpatient_hospital), effective Oct 1, 2024
KY: $0.00 (asc), effective Jan 1, 2026
NE: $68.41 (injectables), effective Jul 1, 2026
OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $73.02 (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.

A9538 Tc99m pyrophosphate