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See a sample rate comparisonHCPCS A9538 Fee Schedule
HCPCS A9538 is classified under Administrative, Miscellaneous and Investigational, in the Diagnostic and Therapeutic Radiopharmaceuticals subgroup.
Technetium Tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries
| Key Fact | Detail |
|---|---|
| Service Type | Administrative, Miscellaneous and Investigational Diagnostic and Therapeutic Radiopharmaceuticals |
| Complexity Level | Low |
| Medicaid Fee Schedule | $45.175 median of the 8 states in the free preview · View Medicaid rates for A9538 |
National average reimbursement for HCPCS A9538 by major payers:
$53.27
BCBS / Anthem
$74.10
UnitedHealthcare
$67.74
Aetna
$56.60
Cigna
Compare published rates across providers.
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HCPCS A9538
5 of 25 sample ratesHigher to lower in this preview
Emory University, Emory University Hospital
Emory University
$192.14Published rateFayette Community Hospital, Inc., Piedmont Fayette Hospital
Fayette Community Hospital Inc
$86.19Published rateTattnall Hospital Company, LLC, Optim Medical Center - Tattnall
$73.01Published rateEmanuel County Hospital Authority, Emanuel Medical Center
$73.01Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$65.33Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS A9538 vs. Other Diagnostic and Therapeutic Radiopharmaceuticals Codes
The table lists codes related to A9538. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| A9537-HCPCS | Low | Technetium Tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries |
| A9538-HCPCS | Low | Technetium Tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries |
| A9539-HCPCS | Low | Technetium Tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS A9538. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the A9538 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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