HCPCS code A9552: FDG PET scan billing, coverage, and modifiers

Key takeaways

HCPCS code A9552 identifies Fluorodeoxyglucose F-18 FDG, a radiopharmaceutical tracer billed per study dose up to 45 millicuries for PET imaging.

A9552 may only be reported alongside specific PET CPT codes (78459, 78608, 78811-78816); pairing it with any other procedure code triggers an NCCI edit.

Medicare covers A9552 for brain indications under NCD 220.6.13 (Alzheimer’s disease and dementias) and NCD 220.6.9 (intractable seizures); oncologic PET coverage falls under NCD 220.6.17 and broader LCD policies.

Practice management software like Pabau helps radiology and nuclear medicine practices track radiopharmaceutical billing, document pre-scan requirements, and reduce claim denials at submission.

HCPCS code A9552 is the billing code for Fluorodeoxyglucose F-18 FDG, the radiopharmaceutical tracer administered before a PET scan. This guide covers the code description, covered indications, CPT pairings, modifier requirements, documentation rules, and reimbursement context for radiology and nuclear medicine billing teams, including the pre-scan blood glucose documentation requirement.

HCPCS code A9552: Description and clinical context

HCPCS code A9552 is maintained by the Centers for Medicare and Medicaid Services, known as CMS, within the Diagnostic and Therapeutic Radiopharmaceuticals category, covering the A9500-A9800 code range. The official descriptor is: Fluorodeoxyglucose F-18 FDG, diagnostic, per study dose, up to 45 millicuries.

FDG is a radioactive glucose analog. When injected intravenously before a Positron Emission Tomography (PET) scan, it is preferentially absorbed by metabolically active tissue, making it the standard tracer for oncologic, neurologic, and cardiac imaging.

The 45 millicurie (mCi) cap represents the maximum single-study dose that can be reported under one unit of HCPCS code A9552. Doses above that threshold require a separate billing consideration with your MAC.

A9552 sits in the HCPCS Level II A-code series, which covers medical and surgical supplies, injectable drugs, and radiopharmaceuticals. Unlike CPT codes that describe the imaging procedure itself, HCPCS code A9552 describes the supply of the tracer.

Both the radiopharmaceutical code and the appropriate PET CPT code must appear on the same claim for the study to reimburse correctly through claims management software or a direct payer submission.

Medicare-covered indications for HCPCS code A9552

Medicare coverage for FDG-PET imaging is condition-specific and depends on the indication being imaged. Oncologic imaging falls under NCD 220.6.17, brain imaging for Alzheimer’s disease and dementias falls under NCD 220.6.13, brain imaging for intractable seizures falls under NCD 220.6.9, and cardiac viability imaging falls under NCD 220.6.8.

Coverage is not automatic for every PET scan order. The billing team must confirm the diagnosis aligns with an approved indication before claim submission.

Brain PET indications

For brain imaging, Medicare covers HCPCS code A9552 when used with CPT 78608 (brain PET; metabolic evaluation) for two specific diagnoses: Alzheimer’s disease and dementias under NCD 220.6.13, and intractable seizures under NCD 220.6.9. Any other neurologic indication requires a Local Coverage Determination (LCD) check with the applicable Medicare Administrative Contractor (MAC).

Oncologic and cardiac PET indications

Oncologic FDG-PET coverage under Medicare is broader but follows a different policy pathway under NCD 220.6.17. Most solid tumor diagnoses (lung, breast, colorectal, lymphoma, melanoma, esophageal, and others) are covered for initial staging, restaging, and treatment monitoring when documented medical necessity supports the order.

Cardiac viability imaging with CPT 78459 uses the FDG tracer billed with A9552 and carries separate coverage rules under NCD 220.6.8 that require physician attestation of the clinical question being answered. CPT 78491 and 78492 also describe myocardial PET imaging, but they use a rest/stress perfusion tracer billed with A9555 or A9526, not A9552.

Good HIPAA compliance guide practices also mean retaining the ordering physician documentation as part of the patient record for audit purposes.

Medicaid coverage varies by state. Do not assume Medicare coverage policies apply to your state Medicaid program without verifying with the specific Medicaid agency or checking your state’s MMIS system.

CPT codes paired with HCPCS code A9552

Per the Medicaid NCCI Manual (Chapter IX, Radiology Services, revised 1/1/2022), HCPCS code A9552 may only be reported alongside the following PET scan CPT codes. Pairing A9552 with any other CPT code triggers an NCCI bundling edit and will result in denial or reversal on audit. Use automated billing workflows to build these pairing rules directly into your charge capture process.

CPT 78491 and 78492 also describe myocardial PET imaging, but they cover rest/stress perfusion studies rather than metabolic viability imaging. Those two codes use a different radiopharmaceutical, billed with HCPCS code A9555 or A9526. Do not pair 78491 or 78492 with A9552 on a claim.

Modifiers and documentation requirements for A9552

Modifier use with HCPCS code A9552 is one of the most misunderstood areas in nuclear medicine billing. Professional-component-only claims use modifier 26, which pairs with modifier TC on the matching technical-component claim.

A separate pair of modifiers, PI and PS, apply only to oncologic PET studies billed with CPT 78811-78816. PI marks an initial treatment strategy PET scan, and PS marks a subsequent treatment strategy PET scan. Neither has anything to do with the professional/technical split.

Modifier 26 requirement for professional component claims

When a radiologist or nuclear medicine physician bills the professional component of a PET or PET-CT scan, they append modifier 26 to the PET CPT code. HCPCS code A9552 is a supply code for the radiopharmaceutical, so it belongs on the technical-component or global claim rather than the professional-component-only claim.

A common billing error is including A9552 on a modifier-26 claim. When that happens, drop A9552 from the professional claim and resubmit. Use digital pre-authorization forms and a structured claim checklist to catch this before submission.

Blood glucose documentation

PET scan procedures require a pre-scan finger-stick blood glucose level documented in the patient record. Per the Medicaid NCCI Manual (Chapter IX, Section 7, revised 1/1/2021), this is an included service reported with CPT 82948 (glucose by reagent strip) or CPT 82962 (glucose by glucose monitoring device).

These are separately billable codes for the glucose test itself, but the documentation must appear in the record to support medical necessity for the FDG administration.

Missing glucose documentation is one of the most common audit findings in PET billing and can trigger retroactive denial of HCPCS code A9552. Clinical documentation software workflows should include a glucose documentation checkpoint before FDG administration, alongside your compliance management software.

Core documentation checklist

• Physician order specifying the clinical indication and PET study type
• Prior authorization number (required by most commercial payers and many MACs)
• ICD-10-CM diagnosis code supporting medical necessity (must align with an approved NCD/LCD indication)
• Pre-scan blood glucose level (CPT 82948 or 82962 result documented in record)
• FDG dose administered, in millicuries (must not exceed 45 mCi under a single A9552 unit)
• Time and date of injection, administered by whom
• Technical and professional component billing split (if applicable), with modifier 26/TC documentation

Streamline radiopharmaceutical billing with Pabau

Pabau's claims management tools help nuclear medicine and radiology teams track charge capture, enforce CPT-to-HCPCS pairing rules, and document pre-scan requirements before a claim is submitted. See how it works in a quick demo.

Book a demo

Reimbursement and fee schedule context for HCPCS code A9552

Reimbursement for HCPCS code A9552 follows the Average Sales Price (ASP) methodology used by CMS for separately payable drugs and radiopharmaceuticals. ASP-based rates are updated quarterly, so the rate applicable to your claim depends on the date of service, not the date of submission. Use the CMS fee schedule lookup tool to confirm the current ASP rate for your jurisdiction before establishing your charge master entry.

Setting a charge master figure far above the ASP-based rate creates a contractual adjustment that looks unusual in payer audits. Most radiology billing advisors recommend setting the charge at 100-115% of the expected ASP payment to allow for reasonable adjustment without creating an outlier profile.

Your MAC may also publish a separate drug fee schedule that determines the actual payment rate for A9552 in your region. Always verify with your MAC’s published quarterly drug update to confirm the operative rate for the current quarter. This rate-tracking work is a core piece of healthcare revenue cycle management for any imaging practice billing radiopharmaceuticals at volume.

For the AAPC Codify HCPCS lookup, search A9552 to find current billing notes, code status, and any active coverage or payment edits that apply to the code in the current year. Commercial payers often follow Medicare ASP methodology but may apply a different multiplier, so verifying your payer-specific contract rate separately is essential for EHR integration guide and revenue cycle accuracy.

Adjacent codes and ICD-10 diagnosis code selection

Selecting the right ICD-10-CM diagnosis code to pair with HCPCS code A9552 determines whether Medicare adjudicates the claim as covered or non-covered. The diagnosis code must directly reflect the covered indication identified in the physician order and the NCD/LCD that applies to the imaging study.

Using a generic or unspecified code, such as a Z-code screening encounter, when a specific diagnosis code exists is one of the fastest routes to a medical necessity denial.

Common ICD-10-CM codes that support A9552 claims

• G30.0, G30.1, G30.8, G30.9: Alzheimer’s disease – brain PET metabolic evaluation
• F01.50, F03.90: Vascular dementia, unspecified dementia – brain PET indication
• G40.x series: Epilepsy and intractable seizures – brain PET metabolic evaluation
• C34.x series: Malignant neoplasm of bronchus and lung – oncologic PET staging/restaging
• C50.x series: Malignant neoplasm of breast – oncologic PET restaging or treatment monitoring
• C81-C85: Hodgkin and non-Hodgkin lymphoma – oncologic PET initial staging or restaging
• C43.x series: Malignant melanoma – oncologic PET coverage
• I25.5: Ischemic cardiomyopathy – cardiac PET viability assessment

This list is illustrative, not exhaustive. Always verify against the applicable NCD and your MAC’s LCD before using a diagnosis code to support a claim for medical forms guide and building the supporting documentation package. The NLM Clinical Table Search API provides programmatic access to HCPCS Level II code data for teams building EHR charge capture integrations.

Claim submission workflow for PET facilities

The claims workflow for HCPCS code A9552 differs depending on whether your facility bills global (combined technical and professional), technical component only (TC modifier), or professional component only (modifier 26). Getting this split wrong is the second most common cause of A9552 claim denials after incorrect diagnosis codes. Maintaining accurate clinical documentation records at the point of care is essential before the claim reaches the biller.

Global billing (Combined technical and professional)

When the facility owns the scanner and employs the interpreting physician, bill the applicable PET CPT code without a TC or 26 modifier, and include HCPCS code A9552 on the same claim. One unit of A9552 represents one study dose up to 45 mCi. Report one unit unless the clinical record documents a dose exceeding 45 mCi, in which case contact your MAC for guidance on additional billing.

Technical component only (TC modifier)

When a hospital or outpatient imaging center provides the scanner and tracer but the reading physician bills separately, append the TC modifier to the PET CPT code and include HCPCS code A9552 on the technical claim. The radiopharmaceutical is a technical supply and belongs on the TC component claim.

Professional component only (Modifier 26)

When a radiologist or nuclear medicine physician bills only the interpretation, append modifier 26 to the PET CPT code. Do not include HCPCS code A9552 on this claim. A9552 is a supply code for the radiopharmaceutical, and it stays on the technical-component or global claim, which is where the tracer was actually administered.

How practice management software supports HCPCS code A9552 workflows

Radiopharmaceutical billing is more operationally intensive than standard procedural coding. The combination of ASP-based pricing, NCCI pairing restrictions, technical/professional modifier requirements, and blood glucose pre-documentation creates multiple failure points that manual charge capture is unlikely to catch consistently.

Practice management and EMR billing software can reduce those failure points by embedding claim rules at the charge entry stage rather than catching them at scrubbing. Comparing dedicated platforms, like those covered in Pabau’s medical billing software roundup, can help you weigh what a system needs to catch before it reaches your MAC.

Pabau’s claims management software lets radiology and nuclear medicine practices build CPT-to-HCPCS pairing checks, track radiopharmaceutical units per claim, and flag incomplete documentation before the claim goes out the door.

The integration between scheduling, clinical documentation, and billing means a PET scan appointment can carry the FDG dose, the glucose check result, and the pre-authorization number through to the claim automatically, rather than relying on manual data entry across three separate systems.

This kind of workflow matters when you are running 20 or 30 FDG-PET studies per week: one missing field on one claim can cost the practice several hundred dollars and a resubmission cycle. For practices also managing paperless HIPAA-compliant documentation, Pabau supports the full digital workflow from patient intake through post-study billing.

Conclusion

FDG-PET billing comes down to three things getting right simultaneously: the correct CPT-to-HCPCS pairing, the diagnosis code matching the approved NCD/LCD indication, and the pre-scan blood glucose documented before the FDG dose. Any one of these missing means a denial and a resubmission cycle.

HCPCS code A9552 is technically straightforward, but the surrounding billing rules create enough complexity to produce consistent claim errors without a structured workflow.

Pabau’s practice management software helps imaging practices build those rules into the charge capture workflow so claims submit correctly the first time. Book a demo to see how Pabau’s claims management and documentation tools work for radiology and nuclear medicine teams.

Continue your research

Need a structured billing framework for your radiology practice? Practice management guide covers how integrated scheduling, documentation, and billing workflows reduce claim errors across high-volume imaging practices.

Managing compliance documentation for nuclear medicine? Patient care management tools explains how digital record-keeping supports audit-ready documentation for regulated diagnostic services.

Also coding infusion visits for imaging patients? CPT 96365 covers IV infusion administration billing for practices running same-day hydration or drug infusions.

Seeing cardiac PET referrals for post-MI patients? ICD-10 code I24.1 covers Dressler’s syndrome, a related diagnosis your cardiology referral sources may document.

Also billing ophthalmology visits at your imaging practice? ICD-10 code H44.9 covers unspecified disorders of the globe.

Looking for a HCPCS code lookup tool? PGM Billing’s free HCPCS lookup tool lets you search HCPCS Level II codes using current CMS data with no subscription required.

Frequently asked questions