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A9500 TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE, UP TO 40 MILLICURIES                                                                                                                                                                                   
 CARDIOLITE® / MIRALUMA®
A9501 TECHNETIUM TC-99M TEBOROXIME, DIAGNOSTIC, PER STUDY DOSE                                                                                                                                                                                
 CardioTec®   TEBO
A9502 TECHNETIUM TC-99M TETROFOSMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 40 MILLICURIES
 MYOVIEW®
A9503TECHNETIUM TC-99M MEDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES


 MDP
A9504 TECHNETIUM TC-99M APCITIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURIES


 ACUTECT®
A9505THALLIUM TL-201 THALLOUS CHLORIDE, DIAGNOSTIC, PER MILLICURIE


 THALLIUM 201
A9507INDIUM IN-111 CAPROMAB PENDETIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES


 PROSTASCINT®
A9508IODINE I-131 IOBENGUANE SULFATE, DIAGNOSTIC, PER 0.5 MILLICURIE


 I-131 MIBG
A9509 IODINE I-123 SODIUM IODIDE, DIAGNOSTIC, PER MILLICURIE

 Use for 1-4 mCi doses of I-123 for whole body imaging for less than 1 mCi and thyroid imaging see A9516
A9510TECHNETIUM TC-99M DISOFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES

 DISIDA
A9512TECHNETIUM TC-99M PERTECHNETATE, DIAGNOSTIC, PER MILLICURIE
 Straight Tech  Technescan Technelite
A9516IODINE I-123 SODIUM IODIDE, DIAGNOSTIC, PER 100 MICROCURIES, UP TO 999 MICROCURIES

 Dx I-123 Capsules. Use for A9516 for Thyroid uptakes and scans, for 1 mCi and greater and whole body imaging see A9509
A9517IODINE I-131 SODIUM IODIDE CAPSULE(S), THERAPEUTIC, PER MILLICURIE
 Rx I-131 Capsules
A9521TECHNETIUM TC-99M EXAMETAZIME, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES

 CERETEC®     HMPAO
A9524IODINE I-131 IODINATED SERUM ALBUMIN, DIAGNOSTIC, PER 5 MICROCURIES
 I-131 Albumin
A9526                                                                                                                                                                                                                                                                                                                                                                                                                                                              NITROGEN N-13 AMMONIA, DIAGNOSTIC, PER STUDY DOSE, UP TO 40 MILLICURIES
 N-13
A9527IODINE I-125, SODIUM IODIDE SOLUTION, THERAPEUTIC, PER MILLICURIE
  
A9528IODINE I-131 SODIUM IODIDE CAPSULE(S), DIAGNOSTIC, PER MILLICURIE
 I-131 Dx caps per mCi
A9529IODINE I-131 SODIUM IODIDE SOLUTION, DIAGNOSTIC, PER MILLICURIE
 Dx I-131 sol per mCi
A9530IODINE I-131 SODIUM IODIDE SOLUTION, THERAPEUTIC, PER MILLICURIE
 Rx I-131 sol per mCi
A9531IODINE I-131 SODIUM IODIDE, DIAGNOSTIC, PER MICROCURIE (UP TO 100 MICROCURIES)
 Dx I-131 up to 100 uCi
A9532IODINE I-125 SERUM ALBUMIN, DIAGNOSTIC, PER 5 MICROCURIES
  
A9535INJECTION, METHYLENE BLUE, 1 ML

 Used typically by Surgeon for Sentinel Node identification in OR alternative to Tc99m Filtered SC
A9536TECHNETIUM TC-99M DEPREOTIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 35 MILLICURIES

 NEOTEC®
A9537TECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES

 CHOLETEC®
A9538TECHNETIUM TC-99M PYROPHOSPHATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES

 PYROLITE® *Use this code for myocardial infarct imaging.  Do not use this code for GBP, RVG or MUGA procedures see A9560
A9539TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES

 Tc-99m DTPA
A9540TECHNETIUM TC-99M MACROAGGREGATED ALBUMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES

 MAA
A9541TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURIES

 SULFUR COLLOID® (SC)
A9542INDIUM IN-111 IBRITUMOMAB TIUXETAN, DIAGNOSTIC, PER STUDY DOSE, UP TO 5 MILLICURIES

 Dx In-111 ZEVALIN®
A9543YTTRIUM Y-90 IBRITUMOMAB TIUXETAN, THERAPEUTIC, PER TREATMENT DOSE, UP TO 40 MILLICURIES

 Rx Y-90 ZEVALIN®
A9544IODINE I-131 TOSITUMOMAB, DIAGNOSTIC, PER STUDY DOSE

 Dx BEXXAR®
A9545IODINE I-131 TOSITUMOMAB, THERAPEUTIC, PER TREATMENT DOSE

 Rx BEXXAR®
A9546COBALT CO-57/58, CYANOCOBALAMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 1 MICROCURIE

 NYCOMED
A9547INDIUM IN-111 OXYQUINOLINE, DIAGNOSTIC, PER 0.5 MILLICURIE

 See codes A9570 and A9571 for WBC and Platelet Imaging
A9548INDIUM IN-111 PENTETATE, DIAGNOSTIC, PER 0.5 MILLICURIE

 Indium DTPA
A9550TECHNETIUM TC-99M SODIUM GLUCEPTATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES

 GLUCOSCAN®
A9551TECHNETIUM TC-99M SUCCIMER, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES

 DMSA
A9552FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES

 FDG /  F-18
A9553CHROMIUM CR-51 SODIUM CHROMATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 250 MICROCURIES

  
A9554IODINE I-125 SODIUM IOTHALAMATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MICROCURIES

  
A9555RUBIDIUM RB-82, DIAGNOSTIC, PER STUDY DOSE, UP TO 60 MILLICURIES

 Rb-82 CardioGen82
A9556GALLIUM GA-67 CITRATE, DIAGNOSTIC, PER MILLICURIE

 GALLIUM
A9557TECHNETIUM TC-99M BICISATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES

 NEUROLITE®
A9558XENON XE-133 GAS, DIAGNOSTIC, PER 10 MILLICURIES

 Xenon
A9559COBALT CO-57 CYANOCOBALAMIN, ORAL, DIAGNOSTIC, PER STUDY DOSE, UP TO 1 MICROCURIE

 Shillings Study Rubratope 57 Cobatope 57
A9560TECHNETIUM TC-99M LABELED RED BLOOD CELLS, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES

 ULTRATAG® or Cold PYP + 99m Tc Code to be used for both the invivo/invitro methods of tagging Red Blood Cells
A9561TECHNETIUM TC-99M OXIDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES

 HDP®
A9562TECHNETIUM TC-99M MERTIATIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES

 MAG-3®
A9563SODIUM PHOSPHATE P-32, THERAPEUTIC, PER MILLICURIE

  
A9564CHROMIC PHOSPHATE P-32 SUSPENSION, THERAPEUTIC, PER MILLICURIE

 Phosphocol      P-32
A9566TECHNETIUM TC-99M FANOLESOMAB, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES

 NeutroSpec™
A9567TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, AEROSOL, PER STUDY DOSE, UP TO 75 MILLICURIES

 DTPA Aerosol For Lung Ventilation Studies
A9568TECHNETIUM TC-99M ARCITUMOMAB, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES
 CEA-SCAN®
 A9569TECHNETIUM TC-99M EXAMETAZIME LABELED AUTOLOGOUS WHITE BLOOD CELLS, DIAGNOSTIC, PER STUDY DOSE                                                                          
 Use this code for infection or inflammation imaging do not use this code for brain imaging see A9517
 A9570INDIUM IN-111 LABELED AUTOLOGOUS WHITE BLOOD CELLS, DIAGNOSTIC, PER STUDY DOSE                                                                                                                                                                              

When prepared with patient WBC use this new code do not use A9547
A9571INDIUM IN-111 LABELED AUTOLOGOUS PLATELETS, DIAGNOSTIC, PER STUDY DOSE                                                                                                                   
 When prepared with patient platelets use this new code do not use A9547
 A9572  INDIUM IN-111 PENTETREOTIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 6 MILLICURIES

 Octreoscan® A9565 was deleted effective 2008, note description change, adjust charge if necessary
A9600STRONTIUM SR-89 CHLORIDE, THERAPEUTIC, PER MILLICURIE

 Rx METASTRON®
A9604SAMARIUM SM-153 LEXIDRONAMM, THERAPEUTIC, PER 150 MILLICURIES

 Rx QUADRAMET®
A9698NON-RADIOACTIVE CONTRAST IMAGING MATERIAL, NOT OTHERWISE CLASSIFIED, PER STUDY

 Non Radioactive Contrast NOC
A9699RADIOPHARMACEUTICAL, THERAPEUTIC, NOT OTHERWISE CLASSIFIED

 RX NOC
J0150Injection Adenosine for therapeutic use, 6 mg (not to be used to report any adenosine phosphate compounds, instead use A9270)

 ADENOCARD
J0152Injection Adenosine for diagnostic use, 30 mg (not to be used to report any adenosine phosphate compounds, instead use A9270)
 ADENOSCAN
J0280Aminophyllin up to 250 MG, inj.
  
J0460Atropine sulfate injection, up to 0.3 mg
 Atropen
J1120Acetazolamide sodium injection, up to 500 mg
 Diamox
J1160Inj, digoxin, up to 0.5 mg
 Lanoxin
J1245Dipyridamole injection, per 10mg
 Persantine IV
J1250Inj dobutamine HCL/250 mg
 Dobutrex
J1265Dopamine injection

INJECTION, DOPAMINE HCL, 40 MG
 Intropin
J1610Glucagon hydrochloride per 1MG
 Glucagen
J1642Inj heparin sodium per 10 units (hep lock flush)
 Heplock
J1800Propranolol HCL injection, up to 1 mg
 Inderal
J1940Furosemide injection up to 20 mg
 Lasix
J2270Morphine sulfate injection, up to 10 mg
  
J2271

Morphine sulfate injection, 100 mg

 


  
 J2785 Regadenoson, 0.1 mg   
J2805Sincalide injection

INJECTION, SINCALIDE, 5 MICROGRAMS
 Kinevac®
J3240Thyrotropin injection 0.9 mg n 1.1 mg vial
 Thyrogen  Thytropar
J3420Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg
  
J3490Drugs Unclassified injection
 NOC
J3590Unclassified biologics
 NOC
J7030Normal saline solution infus (1000 CC)
  
J7040Normal saline solution infus (500ML=1)
  
J7050Normal saline solution infus (250 CC)
  
J9310Rituximab, 100 mg
 RituXan
G3001Admin + supply, tositumomab, 450 mg  (Use this Code for Bexxar)