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See a sample rate comparisonHCPCS A4642 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Indium In-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries
| Key Fact | Detail |
|---|---|
| Service Type | Medical And Surgical Supplies Diagnostic Radiopharmaceuticals |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for A4642 |
National average reimbursement for HCPCS A4642 by major payers:
$742.81
$1,700.88
$1,415.88
$1,323.66
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HCPCS A4642
5 of 25 sample ratesHigher to lower in this preview
Northside Hospital, Inc., Northside Hospital Duluth
Northside Hospital Inc
$4,519.43Published ratePiedmont Hospital, Inc, Piedmont Hospital
Piedmont Healthcare Inc
$3,204.68Published rateDonalsonville Hospital Inc
$1,675.00Published rateHospital Authority Of Valdosta And Lowndes County Georgia, South Georgia Medical Center
Hospital Authority Of Valdosta And Lowndes County Georgia
$1,675.00Published rateNavicent Health Oconee, LLC, Navicent Health Baldwin
Navicent Health Oconee LLC
$1,675.00Published rate
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See a sample payer proposalHCPCS A4642 vs. Other Diagnostic Radiopharmaceuticals Codes
The HCPCS A4642 code is part of the Medical And Surgical Supplies services used for Diagnostic Radiopharmaceuticals. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS A4642 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| A4641-HCPCS | Moderate | Radiopharmaceutical, diagnostic, not otherwise classified |
| A4642-HCPCS | Moderate | Indium In-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries |
| A4648-HCPCS | Low | Tissue marker, implantable, any type, each |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS A4642. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the A4642 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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