HCPCS Level II › A codes A9589 Insti hexaminolevulinate hclInstillation, hexaminolevulinate hydrochloride, 100 mg
Medicare coverage: Carrier judgment Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 1 units per day (clinical), rationale: Prescribing Information Outpatient hospital: max 1 units per day (clinical), rationale: Prescribing Information Medicare pricing for A9589 Medicare Part B drug payment limit (ASP, October 2026) A9589 payment limit: $1,431.00 per 100 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
NDCs that bill under A9589 (CMS ASP NDC-HCPCS crosswalk, October 2026) 10511-3001-02 Cysview, Photocure Inc: 1 billing unit per package (1 KIT in 1 CARTON * 50 mL in 1 SYRINGE, PLASTIC * 50 mL in 1 VIAL, GLASS)Physician Fee Schedule (CY 2026, RVU26D) Status X: statutory exclusion, not paid under the PFS.
Payer policies and prior authorization for A9589 Medicaid fee-for-service Prior authorization required or conditional in IN.
AZ: $1432.34 (outpatient_hospital), effective Jul 1, 2026 CO: $928.74 (chp_plus, non-facility), effective Jul 1, 2026 KY: $0.00 (asc), effective Jan 1, 2026 NE: $1432.33 (injectables), effective Jul 1, 2026 OH: $1432.34 (provider_administered_drugs), effective Jul 1, 2026 OK: $1341.10 (physician, non-facility), effective Jul 1, 2026 TX: $1310.79 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2026 VA: $1432.33 (medical), effective Jul 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.