A9584 Iodine i-123 ioflupaneIodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries
Status X: statutory exclusion, not paid under the PFS.
A9584 appears in 6 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, BlueCross BlueShield of South Carolina, Premera Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Parkinson's Disease (0307) | covered if criteria are met | Feb 24, 2026 | payer document |
| Aetna | Single Photon Emission Computed Tomography (SPECT) (0376) | covered if criteria are met | May 28, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Dopamine Transporter Imaging With Singlephoton Emission Computed Tomography | listed, no stance | payer document | |
| Blue Cross Blue Shield of Massachusetts | Dopamine Transporter Imaging with Single Photon Emission Computer Tomography (918) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Dopamine Transporter Imaging With Single Photon Emission Computed Tomography (DAT-SPECT) (CAM 60154) | listed, no stance | Aug 1, 2026 | payer document |
| Premera Blue Cross | Dopamine Transporter Imaging with Single-Photon Emission Computed Tomography (6.01.54) | listed, no stance | Oct 14, 2026 | payer document |
Prior authorization required or conditional in IN.
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.