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HCPCS Range Contrast Agents/Diagnostic Imaging

• 1 Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml ( Q9951 )

• 2 Injection, iron-based magnetic resonance contrast agent, per ml ( Q9953 )

• 3 Oral magnetic resonance contrast agent, per 100 ml ( Q9954 )

• 4 Injection, perflexane lipid microspheres, per ml ( Q9955 )

• 5 Injection, octafluoropropane microspheres, per ml ( Q9956 )

• 6 Injection, perflutren lipid microspheres, per ml ( Q9957 )

• 7 High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml ( Q9958 )

• 8 High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml ( Q9959 )

• 9 High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml ( Q9960 )

• 10 High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml ( Q9961 )

• 11 High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml ( Q9962 )

• 12 High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml ( Q9963 )

• 13 High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml ( Q9964 )

• 14 Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml ( Q9965 )

• 15 Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml ( Q9966 )

• 16 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml ( Q9967 )

• 17 Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg ( Q9968 )

• 18 Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose ( Q9969 )

• 19 Injection, sulfur hexafluoride lipid microspheres, per ml ( Q9950 )

• 20 Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries ( Q9982 )

• 21 Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries ( Q9983 )