`A9582` Iodine i-123 iobenguane

Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 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 A9582

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for A9582

Payer coverage policies that name A9582

A9582 appears in 5 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Shield of California, BlueCross BlueShield of South Carolina, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Tumor Scintigraphy (0168)	covered if criteria are met	Mar 27, 2026	payer document
Blue Cross & Blue Shield of Mississippi	Myocardial Sympathetic Innervation Imaging In Individuals With Heart Failure	unproven / investigational		payer document
Blue Shield of California	Myocardial Sympathetic Innervation Imaging in Individuals With Heart Failure (6.01.56)	listed, no stance		payer document
BlueCross BlueShield of South Carolina	Myocardial Sympathetic Innervation Imaging in Patients With Heart Failure (CAM 60156)	listed, no stance	Aug 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Myocardial Sympathetic Innervation Imaging in Individuals With Heart Failure (RAD604.012)	listed, no stance	Nov 15, 2025	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

AZ: $2201.63 (asc), effective Oct 1, 2026
KY: $2317.50 (asc), effective Jan 1, 2026
MS: $2317.50 (comprehensive), effective Jul 1, 2026
NE: $5455.78 (injectables), effective Jul 1, 2026
VT: $1761.30 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $793.50 (professional_administered_drugs), effective Jul 1, 2026
WY: $1003.15 (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.

A9582 Iodine i-123 iobenguane