A9584 Insurance Policy Changes

HCPCS A9584 is officially defined as "Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries." HCPCS A9584 is referenced in 4 tracked payer policy changes from Aetna, Blue Cross & Blue Shield of Mississippi, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS A9584 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 14, 2026Medium impact
Single Photon Emission Computed Tomography (SPECT) (CPB 0376, reviewed 2026-05-28)
Aetna's Clinical Policy Bulletin 0376 sets the coverage rules for single photon emission computed tomography (SPECT). Non-cardiac SPECT is considered medically necessary for a list of indications, including osteomyelitis, distinguishing bone from soft tissue infection, pulmonary embolism by SPECT ventilation/perfusion scintigraphy, distinguishing Parkinson's disease from essential tremor using DaTSCAN, localization of abscesses, lymphoma and necrosis differentiation, neuroendocrine tumor diagnosis and staging, presurgical ictal detection of seizure focus in epilepsy in place of PET, and thyroid cancer iodine imaging. SPECT for coronary artery disease diagnosis and prognosis is considered medically necessary, except as outlined in the policy's exclusion criteria. SPECT for a list of other uses, including Alzheimer's disease and dementia, attention deficit/hyperactivity disorder, autism, schizophrenia, stroke, and absolute quantitation of myocardial blood flow, is considered experimental, investigational or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Parkinson's Disease (CPB 0307, reviewed 2026-02-24)
Aetna's Parkinson's disease clinical policy bulletin (CPB 0307, reviewed February 24, 2026) considers carbidopa and levodopa enteral suspension (Duopa) medically necessary for treating motor fluctuations in advanced Parkinson's disease when the listed criteria are met, and considers it experimental, investigational, or unproven for all other indications. Neuropsychological testing (CPT 96132, 96133, 96146) is covered when selection criteria are met, and SPECT scanning (CPT 78607, HCPCS A9584) is covered when selection criteria are met to distinguish Parkinson's disease from essential tremor. The policy also sets criteria for pallidotomy and lists diagnostic tests, non-surgical treatments and surgical procedures it considers experimental, investigational, or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Dopamine Transporter Imaging with Single-Photon Emission Computed Tomography
Dopamine transporter imaging with SPECT using ioflupane may be considered medically necessary when used for individuals with clinically uncertain Parkinson disease or clinically uncertain dementia with Lewy bodies. Use of this imaging is investigational for all other indications. The use of DaT-SPECT for the diagnosis, management, or surveillance of Alzheimer disease is considered out of scope for this policy.
Premera Blue Cross · Identified Jun 18, 2026Medium impact
Medical Policy and Coding Updates - January 2019
Effective January 1, 2019, Tisagenlecleucel code Q2042 and breast MRI codes 77046, 77047, 77048 and 77049 are now reviewed by AIM Specialty Health and require prior authorization, and A9584 (iodine I-123 ioflupane) is now reviewed for medical necessity and requires prior authorization. Breast MRI codes 77058 and 77059 are no longer reviewed by AIM Specialty Health, and the CAR-T codes 0537T through 0540T are listed as not reviewed and noncovered. Effective January 4, 2019, a long list of genetic testing codes beginning with 81120 and 81121 is now reviewed by AIM Specialty Health and requires prior authorization.

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REFERENCE DATA

Payers with rules2

Payers requiring prior auth2

CalViva Health · Effective December 31, 2025
Prior authorization required
CalViva Health CMS-0057-F prior authorization requirements
Community Health Plan of Imperial Valley · Effective December 31, 2025
Prior authorization required
Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does CalViva Health require prior authorization for A9584?

CalViva Health lists A9584 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for A9584?

Community Health Plan of Imperial Valley lists A9584 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS A9584?

There are 4 tracked policy changes affecting HCPCS A9584, including updates from Aetna, Blue Cross & Blue Shield of Mississippi, Premera Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS A9584?

Payers that have issued tracked updates for HCPCS A9584 include: Aetna, Blue Cross & Blue Shield of Mississippi, Premera Blue Cross.

How do I get notified when HCPCS A9584 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS A9584. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS A9584?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for A9584 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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Single Photon Emission Computed Tomography (SPECT) (CPB 0376, reviewed 2026-05-28)

Parkinson's Disease (CPB 0307, reviewed 2026-02-24)

Dopamine Transporter Imaging with Single-Photon Emission Computed Tomography

Medical Policy and Coding Updates - January 2019

Prior authorization required