HCPCS A9542 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | High |
National average reimbursement for HCPCS A9542 by major payers:
$2,831.84
$4,262.84
$3,126.42
$3,455.78
| 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 A9542 | ||||||
United | A9542 | $7858.16 | 1134133002 - PIEDMONT NEWNAN HOSPITAL, INC. | 205077249 - (GA) PIEDMONT NEWNAN HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | A9542 | $4200.00 | 1326191180 - PROFESSIONAL RESOURCES MANAGEMENT OF RABUN, LLC, MOUNTAIN LAKES MEDICAL CENTER | 202012765 | GA | Critical Access Hospital (282NC0060X) |
United | A9542 | $4200.00 | 1457329435 - PAULDING MEDICAL CENTER, INC., WELLSTAR PAULDING HOSPITAL | 582095884 - (GA) PAULDING MEDICAL CENTER INC | GA | General Acute Care Hospital (282N00000X) |
United | A9542 | $4200.00 | 1487684122 - UNION COUNTY HOSPITAL AUTHORITY, UNION GENERAL HOSPITAL | 586025393 - (GA) UNION COUNTY HOSPITAL AUTHORITY | GA | General Acute Care Hospital (282N00000X) |
United | A9542 | $7858.16 | 1437186111 - PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC. | 582179986 - (GA) PIEDMONT ATHENS REGIONAL MEDICAL CENTER INC | GA | General Acute Care Hospital (282N00000X) |
United | A9542 | $4200.00 | 1174512115 - MICHAEL GUILLETTE | 271495988 - (NM) AZTEC URGENT CARE LLC | CO | Physician Assistant (363A00000X) |
United | A9542 | $11082.03 | 1790715381 - NORTHSIDE HOSPITAL, INC., NORTHSIDE HOSPITAL DULUTH | 581954432 - (GA) NORTHSIDE HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | A9542 | $4200.00 | 1710992433 - HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE, JEFFERSON HOSPITAL | 581309961 - (GA) HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE | GA | General Acute Care Hospital (282N00000X) |
United | A9542 | $6441.00 | 1992789721 - PHOEBE PUTNEY MEMORIAL HOSPITAL INC, PHOEBE PUTNEY MEMORIAL HOSPTIAL | 263792403 - PHOEBE PHYSICIAN GROUP INC | GA | General Acute Care Hospital (282N00000X) |
United | A9542 | $4200.00 | 1902855216 - ATLANTA VAMC | 582091280 | GA | General Acute Care Hospital (282N00000X) |
United | A9542 | $4200.00 | 1508361841 - CHRISTOPHER CHAMBERS | 10594994 - COOPERATIVE HEALTHCARE SERVICES INC | GA | Rural Acute Care Hospital (282NR1301X) |
United | A9542 | $7350.00 | 1922178789 - SCOTTISH RITE CHILDRENS MEDICAL CTR, CHILDREN'S HEALTHCARE OF ATLANTA AT SCOTTISH RITE | 580572465 - CHILDRENS HEALTHCARE OF ATLANTA INC | GA | Children's Hospital (282NC2000X) |
United | A9542 | $15323.42 | 1255401519 - THE MEDICAL CENTER INC, PIEDMONT COLUMBUS REGIONAL MIDTOWN | 581685139 - (GA) THE MEDICAL CENTER INC | GA | General Acute Care Hospital (282N00000X) |
United | A9542 | $3977.23 | 1255766531 - MARISSA LIVERIS | 362925195 - ALLERGY & ASTHMA OF DUPAGE, S.C. | IL | Physician Assistant (363A00000X) |
United | A9542 | $3990.00 | 1255401519 - THE MEDICAL CENTER INC, PIEDMONT COLUMBUS REGIONAL MIDTOWN | 581685139 - (GA) THE MEDICAL CENTER INC | 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 A9542 vs. Other Diagnostic and Therapeutic Radiopharmaceuticals Codes
The HCPCS A9542 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 A9542 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 |
|---|---|---|
| A9541-HCPCS | Moderate | Technetium Tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries |
| A9542-HCPCS | High | Indium In-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries |
| A9543-HCPCS | High | Yttrium Y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS A9542. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the A9542 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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