HCPCS A9536 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Administrative, Miscellaneous and Investigational • Diagnostic and Therapeutic Radiopharmaceuticals |
| Complexity Level | Moderate |
National average reimbursement for HCPCS A9536 by major payers:
$474.14
$1,417.84
$1,186.53
$674.00
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS A9536 | ||||||
United | A9536 | $1400.00 | 1790715381 - NORTHSIDE HOSPITAL, INC., NORTHSIDE HOSPITAL DULUTH | 582002413 | GA | General Acute Care Hospital (282N00000X) |
United | A9536 | $2940.00 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | A9536 | $2175.45 | 1689063554 - ATL COLORECTAL SURGERY | 205040872 - (GA) ATL COLORECTAL SURGERY | GA | General Acute Care Hospital (282N00000X) |
United | A9536 | $1400.00 | 1710105119 - THE HOSPITAL AUTHORITY OF MILLER COUNTY, MILLER COUNTY HOSPITAL - PRO FEES | 586010601 - THE HOSPITAL AUTHORITY OF MILLER COUNTY | GA | Critical Access Hospital (282NC0060X) |
United | A9536 | $1400.00 | 1992799050 - GRADY MEMORIAL HOSPITAL CORPORATION, GRADY HEALTH SYSTEMS | 262037695 - GRADY MEMORIAL HOSPITAL CORPORATION | GA | General Acute Care Hospital (282N00000X) |
United | A9536 | $2158.41 | 1225050396 - NORTHSIDE HOSPITAL, INC., NORTHSIDE HOSPITAL CHEROKEE | 581954432 - (GA) NORTHSIDE HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | A9536 | $1400.00 | 1508900101 - MICHAEL KOCH | 208418894 - (GA) PATHOLOGY LAB OF GEORGIA LLC | GA | General Acute Care Hospital (282N00000X) |
United | A9536 | $1393.00 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | A9536 | $3080.00 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | A9536 | $760.00 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | A9536 | $760.00 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | A9536 | $2940.00 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | A9536 | $1400.00 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | A9536 | $3080.00 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | A9536 | $1400.00 | 1306896253 - HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY GEORGIA, SOUTH GEORGIA MEDICAL CENTER | 586004467 - (GA) HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY GEORGIA | GA | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS A9536 vs. Other Diagnostic and Therapeutic Radiopharmaceuticals Codes
The HCPCS A9536 code is part of the Administrative, Miscellaneous and Investigational services used for Diagnostic and Therapeutic 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 A9536 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 |
|---|---|---|
| A9532-HCPCS | Moderate | Iodine I-125 serum albumin, diagnostic, per 5 microcuries |
| A9536-HCPCS | Moderate | Technetium Tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries |
| A9537-HCPCS | Low | Technetium Tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS A9536. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the A9536 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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