HCPCS code A9575: Gadoterate meglumine billing guide

Key Takeaways

HCPCS Code A9575 is defined as Injection, gadoterate meglumine, 0.1 mL and falls under the Diagnostic and Therapeutic Radiopharmaceuticals category maintained by CMS.

Each billing unit equals 0.1 mL of gadoterate meglumine. Most standard adult MRI doses require 15-20 units, so calculating units accurately is critical to avoid overbilling.

The current Medicare non-facility reimbursement rate is approximately $0.09 per 0.1 mL unit. Always cross-reference against the CMS Physician Fee Schedule before submitting claims.

Pabau’s claims management software helps radiology and imaging practices track drug units, attach NDC numbers, and submit A9575 claims with fewer denials.

HCPCS code A9575 is the billing code for injection, gadoterate meglumine, 0.1 mL, a gadolinium-based contrast agent given intravenously during MRI scans. As the gadoterate meglumine HCPCS code, A9575 covers the drug cost only, billed per 0.1 mL alongside the MRI procedure code. Accurate unit counts and a valid National Drug Code (NDC) on every claim are what keep A9575 submissions from getting denied.

Official descriptor: Injection, gadoterate meglumine, 0.1 mL. The Centers for Medicare and Medicaid Services (CMS) maintains this code under the Diagnostic and Therapeutic Radiopharmaceuticals category within the HCPCS Level II system. It was established by CMS transmittal r2849cp and applies to all multi-use and single-dose vial formulations of gadoterate meglumine marketed in the US, including Clariscan (distributed by GE Healthcare) and Dotarem (manufactured by Guerbet).

Gadoterate meglumine is a macrocyclic, ionic gadolinium-based contrast agent (GBCA) used intravenously during MRI procedures such as 70553. Its macrocyclic structure gives it a lower risk of gadolinium dissociation compared to linear agents, a distinction that has clinical relevance when documenting medical necessity for payers that require contrast-agent justification.

Key code properties

Clinical indications for HCPCS code A9575

Gadoterate meglumine is FDA-approved for use in adults and children aged two years and older. Payers expect medical necessity documentation to specify which indication prompted contrast use. Vague orders like “MRI with contrast” are increasingly flagged for audit, so the diagnosis code on the claim must directly support the clinical need for a GBCA.

Common clinically accepted indications include:

• Intracranial lesions: tumors, abscesses, metastatic disease, and demyelinating conditions such as multiple sclerosis, including cases coded to G07
• Spinal pathology: herniated discs with neural compromise, spinal cord tumors, post-surgical assessment, and stenosis such as M48.06
• Vascular malformations: arteriovenous malformations, aneurysms, and vessel wall pathology, including cases documented under M31.6
• Soft tissue and musculoskeletal lesions: joint effusions requiring characterization, soft tissue masses
• Hepatic lesions: liver mass characterization where hepatobiliary-specific agents are not required

Confirm the patient’s renal function before administration. Gadolinium-based contrast agents carry a risk of nephrogenic systemic fibrosis (NSF) in patients with severe renal impairment (eGFR below 30 mL/min/1.73 m²). This contraindication must be documented in the patient record and, where required, on the prior authorization request.

Make sure the ICD-10-CM code on the claim, such as G44.89 for a headache workup, reflects the clinical reason for the MRI rather than the contrast agent itself.

Billing guidelines and unit calculation for A9575

The most consequential decision in A9575 billing is calculating units correctly. Each unit represents 0.1 mL of gadoterate meglumine actually administered to the patient.

How to calculate A9575 units

A9575 units are counted per 0.1 mL of gadoterate meglumine actually administered. The standard adult dose for most MRI indications is 0.1 mmol/kg body weight. At the standard concentration of 0.5 mmol/mL, this equates to 0.2 mL/kg.

For a 75 kg adult, the dose is approximately 15 mL, which means 150 units on the claim (150 x 0.1 mL). Always bill for the volume actually administered, not the full vial volume.

Key billing rules to follow:

• Bill only for actual volume used: Waste from multi-use vials is generally not separately reimbursable under Medicare Part B for radiopharmaceuticals
• Include the NDC number: Medicare and many commercial payers require the 11-digit NDC on the claim in the qualifier-NDC-unit format. A missing A9575 NDC is one of the most common denial triggers, so report the NDC unit count alongside it (many state Medicaid programs expect the unit qualifier UN1)
• Use the correct NDC qualifier: N4 is the required qualifier for NDC on CMS 1500 and UB-04 claims
• Document the dose administered: The patient record must reflect the volume injected, not just the order. This protects against post-payment audit risk

CPT codes paired with A9575

HCPCS code A9575 is never billed in isolation. It always accompanies the appropriate CPT code for the MRI procedure, and the common MRI CPT codes are listed below. AAPC Codify lists the full HCPCS Level II range and associated crosswalks. Common CPT pairings include:

For a full reference to related radiology and imaging CPT codes, consult the current CMS code listings. The CPT code governs the technical and professional component reimbursement, and A9575 covers only the drug cost.

Other cross-sectional imaging procedures pair with their own drug and supply codes. See 74177 for CT abdomen and pelvis with contrast, 72148 for MRI lumbar spine without contrast, 73221 for MRI upper extremity joint without contrast, and 70450 for CT head without contrast.

A9575 reimbursement rate and Medicare fee schedule

A9575 reimbursement runs through the Medicare Part B buy-and-bill model for gadolinium contrast agents. The practice or hospital purchases the drug, administers it, and seeks reimbursement from Medicare. Reimbursement is based on the Average Sales Price (ASP) methodology for Part B drugs, not the Physician Fee Schedule RVU framework used for professional services.

Current reimbursement figures

The Medicare non-facility reimbursement rate for HCPCS code A9575 is approximately $0.09 per 0.1 mL unit. Because a typical adult MRI dose runs to 150+ units, the total drug reimbursement for a single patient encounter is in the range of $13-$15. Always verify the current rate directly via the CMS Physician Fee Schedule before finalizing your fee schedules, as ASP-based rates update quarterly.

Outpatient vs. facility billing (OPPS)

The payment setting changes how A9575 is reimbursed. In the non-facility setting (outpatient radiology center or physician office), the drug is reimbursed under the Part B drug payment rate. Under the Hospital Outpatient Prospective Payment System (OPPS), CMS bundles contrast agents into the MRI procedure’s Ambulatory Payment Classification (APC) rate.

Hospitals billing on a UB-04 must still list A9575 on the claim for tracking and volume reporting, but the incremental drug reimbursement is absorbed into the APC payment.

Modifiers, prior authorization, and payer-specific rules

Modifier requirements for A9575 depend on the payer and the clinical scenario. Medicare generally does not require a drug-specific modifier on the A9575 line, but the MRI procedure CPT code may require modifier 26 (professional component) or TC (technical component) when billing split between the radiology group and the facility.

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Common modifiers applied to A9575 claims

• No modifier (most Medicare Part B scenarios): A9575 is reported without a modifier when the drug is purchased and administered in a non-facility setting and billed globally
• Modifier JW: Drug waste. If a portion of a vial is discarded and your payer allows separate waste billing, append JW to a second line item reporting the wasted units. Medicare guidance on this varies by MAC, so verify with your local contractor
• Modifier JZ: No drug waste. Required for dates of service on or after July 1, 2023 (voluntary reporting began January 1, 2023) on single-dose vial lines where no drug was wasted. Omitting JZ on single-dose vial claims will result in denial
• Modifier 59: Distinct procedural service. Use when A9575 is billed alongside another drug on the same date and you need to distinguish the injection events
• Modifier KX: Requirements met. Some payers ask for KX to confirm the documentation supports medical necessity under their local coverage determination (LCD)
• Modifier UD: 340B-acquired drug. Providers billing gadoterate meglumine purchased under a 340B agreement append UD and bill their acquisition cost

Prior authorization requirements

Medicare does not require prior authorization for A9575 as a standalone drug code, but the MRI procedure itself may be subject to prior auth depending on the Medicare Advantage plan. Commercial payers are more variable. According to GE Healthcare’s reimbursement guidance, commercial payers may require prior authorization for procedures involving gadolinium contrast agents.

Check each payer’s portal or call their provider services line before the scheduled scan, particularly for Medicare Advantage, Blue Cross, Aetna, Cigna, and UnitedHealthcare plans. Using drug tracking workflows within your practice management system can flag missing authorizations before the patient arrives.

NC Medicaid has specific billing rules for gadoterate meglumine. Per the NC Medicaid billing bulletin, providers must bill gadoterate meglumine using HCPCS code A9575 specifically, not an unlisted radiopharmaceutical code. Other state Medicaid programs have adopted similar policies, so always check your state’s Medicaid fee schedule using the relevant procedure code fee schedules reference to confirm current rules.

Comparing A9575 with related gadolinium HCPCS codes

Clariscan and Dotarem are the two brand names for gadoterate meglumine, and a Clariscan vs Dotarem choice makes no difference to the code: both bill under A9575. Gadoterate meglumine is one of several gadolinium-based contrast agents with distinct HCPCS codes. Selecting the wrong code, even between two gadolinium agents, is a coding error that can trigger audits and clawbacks. The key differentiator is the specific chemical formulation and its manufacturer’s NDC range.

Never use A9579 (NOS) when a specific code exists for the agent administered. Gadopentetate dimeglumine (Magnevist) has no dedicated brand-specific HCPCS code of its own and is billed under the A9579 catch-all instead. Payers match the NDC on the claim against the expected NDC range for the billed HCPCS code, so an A9575 claim submitted with a Magnevist NDC will be denied for code-NDC mismatch.

Verify your medication inventory management records confirm which product was actually used before building the claim. Practices administering antiemetics alongside contrast injections, such as J2765 for metoclopramide, should apply the same NDC-matching discipline to avoid mismatched drug lines.

Integrating A9575 billing into your practice workflow

A9575 claims involve more moving parts than a typical service code: the drug cost, the procedure CPT, the NDC, the billing unit count, and the modifier layer all need to align before submission. Manual entry across all these fields on every claim is where errors compound.

Imaging centers and radiology practices with strong EHR integration typically see fewer denial cycles because the administered dose documented in the clinical record flows directly into the claim without re-keying. The dosing event, the NDC, and the unit count are captured once at the point of care and pulled through to the claim automatically.

For practices managing multiple contrast agents across different modalities, structured digital intake forms that capture contrast agent selection at the order stage reduce the risk of the wrong HCPCS code being applied. When the clinician documents “gadoterate meglumine” in the structured field rather than a free-text note, the billing system can auto-map to A9575 rather than relying on a billing coder to interpret handwritten orders.

Practices also benefit from linking A9575 billing to HIPAA-compliant clinic software that maintains an auditable trail of who administered the contrast, the volume injected, the batch number, and the patient consent. Payer audits on GBCA claims are becoming more common as high-volume utilization draws scrutiny.

Missing documentation is the primary reason audits result in repayment demands rather than clean closures. Connecting your billing and clinical record management workflows within a single platform closes that risk by design.

For practices processing large volumes of imaging claims, refer to our overview of practice management software to understand how integrated billing systems support HCPCS drug code workflows alongside procedure billing. Also see the related guide on ADHD screening codes for a comparable reference structure on procedure-level coding.

Conclusion

HCPCS code A9575 billing fails most often not because the code is wrong, but because the units are miscalculated, the NDC is missing, or modifier JZ is omitted on single-dose vial claims. Getting those three elements right on every submission prevents the majority of A9575 denials before they happen.

Pabau’s claims management software gives radiology and imaging practices a structured way to capture drug codes, NDC numbers, and administered volumes at the point of care and carry that data through to claim submission without manual re-entry. To see how Pabau handles HCPCS drug billing workflows, book a demo with the team.

Continue your research

Need a related imaging code? CPT 70450 covers CT head without contrast, a common companion order when a contrast MRI is not an option.

Managing records alongside billing? EHR integration shows how connecting the administration record to the claim cuts coding errors.

Want a broader coding reference? Practice management software outlines how one platform handles HCPCS and CPT claim workflows together.

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