CommercialBilling CodesMedium impact
09.00.32ak, Reimbursement for Radiopharmaceutical Agents
Independence Blue Cross·PA · Nuclear Medicine, Radiology, Oncology·Claims & Billing
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy 09.00.32ak to version 09.00.32al effective 10/01/2025, adding HCPCS code A9616 to the radiopharmaceutical agents policy. The policy clarifies that radiopharmaceutical agents used with PET scans are bundled into procedure payments and not separately reimbursable, except those with CMS pass-through status. Agents used with other modalities may be reimbursable in office or facility settings depending on provider type.
Action Required
By October 1, 2025: Billing team must update all billing software and claims submission processes to reflect the addition of HCPCS code A9616 to the covered radiopharmaceutical agents list. Review encounter templates and billing guidelines to ensure providers understand that radiopharmaceutical agents used with PET scans (including A9515, A9586, A9587, A9588, A9591, A9592, A9593, A9594, and A9616) cannot be billed separately—reimbursement is bundled into the PET procedure payment. For radiopharmaceutical agents used with non-PET modalities, verify billing is submitted from the appropriate provider type (professional providers in office settings or through facility contracts). Audit recent claims (past 90 days) for A9616 to identify any incorrectly billed or separately reimbursed claims and take corrective action. Train billing staff and providers on the distinction between PET and non-PET radiopharmaceutical billing. Failure to comply will result in claim denials and potential overpayment recovery.