HCPCS Code Q9957: Injection, perflutren lipid microspheres, per mL

Key Takeaways

HCPCS Code Q9957 describes injection, perflutren lipid microspheres, per mL and is the code used to bill Definity ultrasound contrast agent in professional and office settings.

Bill two units of Q9957 per vial of Definity; each unit represents 1 mL of the agent according to the Definity Reimbursement Guide 2025.

Hospital outpatient settings use C-codes rather than Q9957; Q9957 is reserved for professional claims billed with echocardiography CPT codes such as 93306 or 93307 (transthoracic) or 93312 (transesophageal).

Pabau’s claims management software helps cardiology and imaging practices track Q9957 billing alongside echocardiography procedures and reduce claim errors.

HCPCS Code Q9957 — injection, perflutren lipid microspheres, per mL — is the billing code for Definity ultrasound contrast agent in professional and office settings. This guide covers units of service, modifier use for discarded drug, CPT code pairings, Medicare coverage rules, ICD-10 medical necessity, and payer-specific policies for echocardiography, with notes on where claims management software can catch errors before submission.

Q9957 code description and clinical context

HCPCS Code Q9957 is the permanent HCPCS Level II code maintained by CMS for the injection of perflutren lipid microspheres, per mL. It falls within the Contrast Agents/Diagnostic Imaging range Q9950-Q9983 and is used specifically to bill the supply of Definity, the branded ultrasound contrast agent (UCA) manufactured by Lantheus Medical Imaging.

Other codes in the same range follow a similar supply-billing pattern, including HCPCS code Q9966 billing guide. For another example of a recently added injectable drug HCPCS code, see our HCPCS code J9299 billing guide.

Definity is perflutren lipid microsphere injectable suspension. It enhances the border delineation of the left ventricular endocardium during echocardiography in patients who have suboptimal baseline imaging.

Common indications include suspected structural or valvular disease, such as infective endocarditis (ICD-10 code I39), and pre- or post-procedural assessment alongside invasive studies like CPT code 93451. Because it is a separately billable supply rather than a bundled service, coders must report it alongside the appropriate echocardiography procedure code, not in isolation.

Q9957 code properties at a glance

Units of service: How many units of Q9957 to bill per vial

The unit count for Q9957 is one of the most common billing errors in echocardiography contrast coding. Each unit of Q9957 represents 1 mL of perflutren lipid microspheres.

According to the Definity Reimbursement Guide 2025 published by Lantheus, Definity is supplied in a 2 mL single-use glass vial with a 1.5 mL liquid fill. The billing convention is two units (2 units) per vial.

Billing one unit when two vials are administered, or billing the full vial as one unit, leads to either underpayment or denial. Verify the actual volume administered against the vial size documented in the procedure record before submitting.

Modifier JW and modifier JZ: Billing for unused drug

When a portion of a single-dose vial is not administered, CMS policy requires coders to account for the discarded amount using modifiers. Modifier JW indicates drug amount discarded or not administered to any patient. Modifier JZ (zero waste) is used when no drug is wasted from a single-dose container.

These modifiers apply to Q9957 under Medicare Part B buy-and-bill guidelines. Practices should document waste in the patient record and confirm individual MAC requirements, as policies differ between jurisdictions. HCPCS code J7323 uses this same JW/JZ modifier logic for another single-dose-vial drug.

Practices administering Definity alongside other infusions can standardize this volume documentation with a structured template, such as our IV therapy patient intake template.

CPT codes paired with Q9957 in echocardiography billing

Q9957 is a supply code. It never stands alone on a claim. The American Society of Echocardiography (ASE) coding guidance specifies that coders should report the contrast agent supply code alongside the applicable echocardiography procedure code.

This pairing pattern is common across drug-supply codes. IV push administration, for example, is billed with CPT code 96374 alongside the relevant drug code. For an overview of how unclassified biologics are handled as supply codes, see our HCPCS code J3590 guide.

The pairing depends on the type of study performed.

• CPT 93306 – Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography
• CPT 93307 – Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording when performed, complete, without spectral or color Doppler echocardiography
• CPT 93308 – Echocardiography, transthoracic, real-time (2D), follow-up or limited study
• CPT 93312 – Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording)
• CPT 93325 – Doppler echocardiography color flow velocity mapping (add-on code)

Report the appropriate echo CPT code first, then Q9957 on a separate line with the mL unit count. Both codes should share the same date of service.

Good medical documentation workflows ensure the procedure note records which contrast agent was used, the volume given, and the specific CPT procedure performed. This same detail feeds directly into the superbill generated for the claim; see our guide to superbills for how it translates into billable line items.

Recently added injectable-drug HCPCS codes follow the same reporting logic: pair the supply code with the applicable administration or procedure CPT code. Examples include billing guide for Gammaplex injection and Vedolizumab injection billing guide.

Office vs. hospital outpatient billing: Q9957 vs. C-codes

HCPCS Code Q9957 applies to professional claims billed in non-facility settings, including physician offices and free-standing imaging centers. Hospital outpatient departments operating under the Outpatient Prospective Payment System (OPPS) use C-codes instead.

C-codes are temporary HCPCS codes created by CMS specifically for hospital outpatient use. They cover the same agents but route through OPPS payment rather than the Medicare Physician Fee Schedule (MPFS). Submitting Q9957 from a hospital outpatient place of service (POS 22 or POS 19) will result in denial or non-reimbursement on the facility claim.

For a broader comparison of platforms that handle both professional and facility claim routing, see our guide to the best medical billing software in the US.

Medicare coverage rules for Q9957

There is no National Coverage Determination (NCD) specific to Q9957. Coverage is decided at the carrier level, so each Medicare Administrative Contractor (MAC) applies its own Local Coverage Determination (LCD) and billing article to the underlying echocardiography study.

In the physician office and non-facility setting, Definity is separately payable under Medicare Part B. Payment follows the quarterly Average Sales Price (ASP) file rather than a fixed fee, so the allowance changes each quarter. Standard Part B cost sharing applies, with the patient responsible for 20% coinsurance after the deductible.

Because Definity is supplied in a single-use vial, Medicare reimburses the amount injected plus any documented discarded remainder. Record the total volume drawn, the volume administered, and the waste in the procedure note so the units billed are supported on audit.

Coverage still depends on medical necessity. The record must show that the echocardiography LCD criteria are met and that contrast was clinically indicated, typically a suboptimal baseline study that needed left ventricular opacification.

ICD-10 codes that support medical necessity for Q9957

Q9957 does not carry its own diagnosis codes. Medical necessity is driven by the underlying cardiac condition that prompted the echocardiogram, not by the fact that the baseline images were suboptimal. Report the diagnosis that justifies the study, then support contrast use in the documentation.

The covered code list is defined by the applicable echocardiography LCD and its billing and coding article (for many MACs, CMS article A56625). Any diagnosis not on that list is denied as not medically necessary, so confirm the current covered codes for your jurisdiction before submitting.

The codes below are common examples of underlying conditions that support a contrast echo. They are illustrative, not a substitute for the payer’s covered list.

When an echo is performed with no clinical indication, it is treated as screening and must carry the appropriate screening diagnosis code, which most payers do not cover for contrast.

Payer-specific policies for Q9957

Commercial payers do not always mirror Medicare. Some follow the ASP-based Part B model, while others reimburse Definity under a contracted rate or bundle it into the imaging payment. Check each plan’s radiopharmaceutical and contrast media reimbursement policy before you bill.

A few payers require prior authorization for contrast echocardiography or limit coverage to specific indications. Others apply the same NCCI edits as Medicare, which bundle the injection service into the echo procedure so it cannot be billed separately.

Across all payers, documentation is the deciding factor. A physician order or protocol for contrast, the reason the baseline study was suboptimal, the agent and volume administered, and any waste should all appear in the record to support the claim.

Q9957 claim submission checklist

Run through these points before releasing a Q9957 claim.

• Confirm the place of service is non-facility (office or free-standing center); hospital outpatient claims use C-codes, not Q9957.
• Report the correct unit count, one unit per mL, with two units for a standard Definity vial.
• Pair Q9957 with the applicable echocardiography CPT code (such as 93306, 93307, or 93312) on the same date of service.
• Attach a diagnosis code that reflects the underlying cardiac condition and appears on the payer’s covered list.
• Document that the baseline study was suboptimal and that contrast improved endocardial border delineation.
• Record the volume drawn, administered, and discarded, and apply waste modifiers per your MAC’s guidance.
• Verify the current quarterly ASP allowance and the specific payer policy before submission.

Conclusion

Q9957 is a supply code for Definity that pays cleanly when three things line up: the right place of service, the correct two-units-per-vial count, and a covered diagnosis paired with the echo procedure. Getting any one of these wrong is the usual cause of denials.

Treat coverage as MAC- and payer-specific, verify the ASP allowance each quarter, and keep contrast use well documented. A claims workflow that captures units, modifiers, and diagnosis links at the point of care makes correct Q9957 billing routine rather than a recurring audit risk.

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