A9538 Tc99m pyrophosphate

What A9538 is

Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries

HCPCS Level II long description, CMS October 2026 file. See the A codes page for the full section.

Medicare payment for A9538 (CY2026)

This code has no Physician Fee Schedule rate: Carrier-priced - the Medicare contractor sets the price. It may be paid under a different fee schedule (clinical laboratory, DMEPOS, anesthesia) or not paid at all - check the relevant CMS schedule.

Medically Unlikely Edit (MUE)

Medicare caps A9538 at 1 unit per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Code Descriptor / CPT Instruction. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with A9538? These codes are bundled into it

A9538 is a Column 1 code in 1 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

A9538 is bundled into these codes

A9538 appears as a Column 2 code in 24 active edits. Reported with one of these Column 1 codes on the same date of service, A9538 is the code that denies.

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.