IDTF Supplies and Ancillary Procedures - JE Part B
Independent Diagnostic Testing Facility (IDTF) Supplies and Ancillary Procedures
Every IDTF will have a specific and unique list of HCPCS codes for which it can be paid.
The below CPT codes do not imply coverage of the procedure. All of the procedure codes are subject to Medicare rules and regulations, applicable Local Coverage Decisions (LCD's), and medical necessity. This list was compiled based on current billing patterns. Therefore, some codes have been inadvertently omitted.
If the procedure code is not included in the table below, providers will need to send in a written request explaining the procedure they are performing. If the medical directors determine it to be an appropriate diagnostic procedure that can be safely performed in an IDTF, it will be added to the provider's file.
| HCPCS Code | Code Description |
|---|---|
| A4642 | In111 satumomab |
| A9500 | Tc99m sestamibi |
| A9502 | Tc99m tetrofosmin |
| A9503 | Tc99m medronate |
| A9504 | Tc99m apcitide |
| A9505 | Tl201 thallium |
| A9507 | In111 capromab |
| A9508 | I131 iodobenguate, dx |
| A9509 | Iodine i-123 sod iodide mil |
| A9510 | Tc99m disofenin |
| A9512 | Tc99m pertechnetate |
| A9516 | Iodine i-123 sod iodide mic |
| A9521 | Tc99m exametazime |
| A9524 | I131 serum albumin, dx |
| A9526 | Nitrogen n-13 ammonia |
| A9528 | I131 iodide sol, dx |
| A9529 | I131 iodide sol, dx |
| A9531 | I131 max 100uci |
| A9532 | I125 serum albumin, dx |
| A9536 | Tc99m depreotide |
| A9537 | Tc99m mebrofenin |
| A9538 | Tc99m pyrophosphate |
| A9539 | Tc99m pentetate |
| A9540 | Tc99m maa |
| A9541 | Tc99m sulfur colloid |
| A9542 | In111 ibritumomab, dx |
| A9546 | Co57/58 |
| A9547 | In111 oxyquinoline |
| A9548 | In111 pentetate |
| A9550 | Tc99m gluceptate |
| A9551 | Tc99m succimer |
| A9552 | F18 fdg |
| A9553 | Cr51 chromate |
| A9555 | Rb82 rubidium |
| A9556 | Ga67 gallium |
| A9560 | Tc99m labeled rbc |
| A9561 | Tc99m oxidronate |
| A9562 | Tc99m mertiatide |
| A9566 | Tc99m fanolesomab |
| A9567 | Technetium tc-99m aerosol |
| A9583 | Gadofosveset trisodium inj |
| A9954 | I125 iothalamate, dx |
| A9557 | Tc99m bicisate |
| A9558 | Xe133 xenon 10mci |
| A9559 | Co57 cyano |
| A9569 | Technetium tc-99m auto wbc |
| A9570 | Indium in-111 auto wbc |
| A9571 | Indium in-111 auto platelet |
| A9572 | Indium in-111 pentetreotide |
| A9575 | Inj gadoterate meglumi 0.1ml |
| A9576 | Inj prohance multipack |
| A9577 | Inj multihance |
| A9578 | Inj gadobenate dimeglumine multihance multipack |
| A9579 | Gad-base mr contrast nos,1ml |
| A9580 | Sodium fluoride f-18 |
| A9581 | Gadoxetate disodium inj |
| A9582 | Iodine i-123 iobenguane |
| A9584 | Iodine i-123 ioflupane |
| A9585 | Gadobutrol injection |
| A9586 | Florbetapir f18 |
| A9587 | Gallium ga-68 |
| A9588 | Fluciclovine f-18 |
| A9591 | Fluoroestradiol f 18, diagnostic, 1 millicurie |
| A9592 | Copper Cu-64, Dotatate, Diagnostic, 1 millicuri (1 mCi) |
| A9593 | Gallium ga-68 psma-11 (UCSF) |
| A9594 | Gallium ga-68 psma-11 (UCLA) |
| A9595 | Piflufolastat f-18 |
| A9596 | Gallium 68-ga Gozetotide/PSMA-11 (Illuccix®) |
| A9597 | Pet dx for tumor id, noc |
| A9598 | Pet dx for non-tumor id, noc |
| A9608 | Posluma (Flotufolastat F-18) |
| J0153 | Inj Adenosine |
| J1245 | Dipyridamole (Persantin) |
| J1610 | Injection; glucagon hydrochrloride or glucagen, per 1 mg |
| J2785 | Regadenoson injection |
| J2805 | Sincalide injection |
| Q9953 | Inj iron-based magnetic resonance contrast agent per ml |
| Q9954 | Oral mr contrast, 100 ml |
| Q9965 | Locm 100-199mg/ml iodine, 1ml |
| Q9966 | Locm 200-299mg/ml iodine,1ml |
| Q9967 | Locm 300-399mg/ml iodine,1ml |
| Q9982 | Flutemetamol f18 diagnostic |
| Q9983 | Florbetaben f18 diagnostic |
| 23350 | Injection for shoulder x-ray |
| 24220 | Injection for elbow x-ray |
| 25246 | Injection for wrist x-ray |
| 27093 | Injection for hip x-ray |
| 27095 | Injection for hip x-ray |
| 27096 | Inject sacroiliac joint |
| 27369 | Njx contrast kne arthg/CT/MRI |
| 27370 | Injection for knee x-ray |
| 27648 | Injection for ankle x-ray |
| 62302 | Myelography lumbar injection |
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