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Reimbursement update for A9587: Gallium GA-68
August 9, 2021

This article is for technical diagnostic imaging facilities and multi-specialty physician groups caring for our members

Based on our review of claims processed for A9587 (Gallium GA-68, dotatate, diagnostic, 0.1 millicurie), we will update our reimbursement for A9587 on October 1, 2021. On that date, we will move from a global payment to a per unit cost. This change applies to all products.

Code Current Fee New rate, effective October 1, 2021
A9587 $3,604.00 $66.74 per unit

Our review of prior claims found that some providers who had billed for more than one unit of A9587 were reimbursed more than the global fee of $3,604.  We will retrospectively adjust claims billed with multiple units prior to October 1, 2021 to allow only one unit of service at the current fee ($3,604).  If you have affected claims, your claim will be adjusted so that you receive the global payment of $3,604.