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See a sample rate comparisonHCPCS A9516 Fee Schedule
HCPCS A9516 is classified under Administrative, Miscellaneous and Investigational, in the Diagnostic and Therapeutic Radiopharmaceuticals subgroup.
Iodine I-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries
| Key Fact | Detail |
|---|---|
| Service Type | Administrative, Miscellaneous and Investigational Diagnostic and Therapeutic Radiopharmaceuticals |
| Complexity Level | Low |
| Medicaid Fee Schedule | $48.97 median of the 8 states in the free preview · View Medicaid rates for A9516 |
National average reimbursement for HCPCS A9516 by major payers:
$88.19
BCBS / Anthem
$111.23
UnitedHealthcare
$102.84
Aetna
$123.46
Cigna
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HCPCS A9516
5 of 25 sample ratesHigher to lower in this preview
Northside Hospital, Inc., Northside Hospital Cherokee
Northside Hospital Inc
$310.67Published rateDonalsonville Hospital Inc
$109.25Published rateChildrens National Medical Center
Childrens Hospital
$101.84Published rateSola Kim
Lowcountry Lung Critical Care PA
$89.59Published rateThomas Kaelin
Lowcountry Lung Critical Care PA
$89.58Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS A9516 vs. Other Diagnostic and Therapeutic Radiopharmaceuticals Codes
The table lists codes related to A9516. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| A9515-HCPCS | High | Choline c-11, diagnostic, per study dose up to 20 millicuries |
| A9516-HCPCS | Low | Iodine I-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries |
| A9517-HCPCS | Low | Iodine I-131 sodium iodide capsule(s), therapeutic, per millicurie |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS A9516. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the A9516 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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