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March 7, 2013Revised: 12.11.23

Radiopharmaceutical Drugs – Billing Instructions

Claims submitted for radiopharmaceutical drugs (HCPCS codes A9500 – A9700) must include either invoice information or a copy of the actual invoice for pricing purposes if nothing else is indicated by CMS.

For electronic claims, report the invoice information in the electronic Documentation Field (Loop 2300, NTE Segment (header level) or Loop 2400, NTE Segment (line level)).

The name of the drug and the exact dosage administered must appear in the Documentation Field.

  • If the submitted charge matches the actual invoice cost, add note "Actual Invoice Cost" in the Documentation Field.
  • If the submitted charge does not match the actual invoice cost, the following information must be included in the Documentation Field, using these abbreviations:
    • Des = Description/Name of agent (e.g., Des=TC99m MDP)
    • QS = Quantity shipped (e.g., QS=100 mci)
    • TA = Total amount charged for quantity shipped in dollars and cents with the decimal (e.g., TA=$57.40)
    • UP = Unit Price in dollars and cents with the decimal (e.g., UP = $0.57 per mci) (Optional)
    • DG = Dosage given (e.g., DG=25 mci)
  • In lieu of submitting the invoice information, you may use the Paperwork (PWK) process and send a copy of the invoice via fax or mail.

If you are approved to submit paper claims, submit this information in Item 19 of the CMS-1500 claim form and provide a copy of the actual invoice.

Claims for radiopharmaceutical drugs received without the invoice information or the actual invoice may be denied or delayed.

CMS has established pricing information for some radiopharmaceuticals. Those radiopharmaceuticals established reimbursement amounts do not require the information noted above. Those drugs with an established reimbursement are available at website


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