A9502 — Technetium tc-99m tetrofosmin, diagnostic, per study dose

What the market charges

Across 973 negotiated rates, the middle 80% fall between $49 and $245, with a median of $98.

What Medicare pays

Medicare allowed an average of $182 for this code, across 378,762.6 services billed by 2,655 providers. At the median, the market charges less than Medicare pays for this code — 46% less.

Where this is billed, and what it costs there

The states billing A9502 most, by Medicare service volume, each compared against the national average of $182. Each links to the providers Mishe lists there.

• Florida — 456 providers billed it, Medicare allowed $368 — 102% above the national average
• California — 239 providers billed it, Medicare allowed $95 — 48% below the national average
• New York — 174 providers billed it, Medicare allowed $339 — 86% above the national average
• Arizona — 132 providers billed it, Medicare allowed $95 — 48% below the national average
• Georgia — 166 providers billed it, Medicare allowed $113 — 38% below the national average
• Texas — 315 providers billed it, Medicare allowed $94 — 48% below the national average
• Maryland — 134 providers billed it, Medicare allowed $98 — 46% below the national average
• South Carolina — 67 providers billed it, Medicare allowed $113 — 38% below the national average

Claim-editing rules

These are National Correct Coding Initiative procedure-to-procedure edits — the rules a payer applies when deciding whether two codes billed together are both payable.

Codes this one absorbs

Billed together, A9502 is the payable code and these are not separately payable. 1 pairs in total.

• A9512 — no modifier can override this edit

Codes that absorb this one

Billed alongside any of these, A9502 is not separately payable. 41 pairs in total.

• 38792 — no modifier can override this edit
• 78018 — no modifier can override this edit
• 78195 — no modifier can override this edit
• 78226 — no modifier can override this edit
• 78227 — no modifier can override this edit
• 78264 — no modifier can override this edit
• 78265 — no modifier can override this edit
• 78266 — no modifier can override this edit
• 78278 — no modifier can override this edit
• 78282 — no modifier can override this edit
• 78290 — no modifier can override this edit
• 78300 — no modifier can override this edit

Other codes

• 99214 — Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
• 99213 — Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more
• 97530 — Therapy procedure using functional activities
• 99232 — Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes
• 97112 — Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes
• 99233 — Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes
• 88305 — Pathology examination of tissue using a microscope, intermediate complexity
• 99309 — Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes
• 87798 — Detection test by nucleic acid for organism, amplified probe technique
• 98941 — Chiropractic manipulative treatment, 3-4 spinal regions

Deploy this for your team

Every figure on this page came from published payer and Medicare data, assembled by Mishe. The same pricing, claim-editing and care-pathway intelligence runs underneath the plans Mishe operates.

• Contact Mishe to learn how to deploy these resources for your team
• Guides to direct-pay healthcare
• Cash prices by procedure
• Find a provider by state

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