Medicare AdvantageBilling CodesMedium impact
MA09.009z, Reimbursement for Radiopharmaceutical Agents
Independence Blue Cross·PA · Nuclear Medicine, Radiology, Oncology +1 more·Claims & Billing
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy MA09.009z to MA09.009aa effective 10/01/2025, adding CPT/HCPCS code A9616 to the radiopharmaceutical agents coverage list. The policy maintains that radiopharmaceutical agents used with PET scans are not eligible for separate reimbursement (included in procedure payment), while agents used with other modalities may be reimbursed when purchased and administered by professional providers in office settings or in facilities per contract.
Action Required
By October 1, 2025: Billing team must update billing system and fee schedules to include new code A9616 in the radiopharmaceutical agents policy MA09.009aa. Verify all listed HCPCS codes (A9515, A9586, A9587, A9588, A9591, A9592, A9593, A9594, A9616) are correctly configured as NOT eligible for separate reimbursement when used with PET scans. Confirm that radiopharmaceutical agents used with non-PET procedures route to appropriate reimbursement pathways (office vs. facility billing). Update internal policy documentation and provider communication materials to reference the new MA09.009aa policy version. Ensure claims billing A9616 with PET procedures are automatically denied for separate reimbursement per bundled payment rules. Educate providers that participating providers may not bill members for PET-associated radiopharmaceutical agents.