A9516 — Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries
A9516 is a HCPCS Level II code for iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries. It belongs to the Transportation, Medical & Surgical Supplies, Administrative section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusC
Contractor-priced. Your MAC establishes the RVUs and the payment amount case by case, usually after reviewing documentation. There is no national amount to compute.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of A9516 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 4 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- outpatient
- 4 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for A9516
- Long descriptor
- Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries
- Short descriptor
- Iodine i-123 sod iodide mic
- Added
- January 1, 2003
- BETOS
- I1E
- Pricing indicator
- 57 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Other carrier priced.
Codes adjacent to A9516
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A9516 is not quite right, the correct code is very often within a few positions of it.
- A9506Graphite crucible for preparation of technetium tc 99m-labeled carbon aerosol, one crucible
- A9507Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries
- A9508Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie
- A9509Iodine i-123 sodium iodide, diagnostic, per millicurie
- A9510Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries
- A9512Technetium tc-99m pertechnetate, diagnostic, per millicurie
- A9513Lutetium lu 177, dotatate, therapeutic, 1 millicurie
- A9515Choline c-11, diagnostic, per study dose up to 20 millicuries
- A9517Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie
- A9520Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries
- A9521Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries
- A9524Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries
- A9526Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries
- A9527Iodine i-125, sodium iodide solution, therapeutic, per millicurie
- A9528Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie
- A9529Iodine i-131 sodium iodide solution, diagnostic, per millicurie
Questions about A9516
What is HCPCS code A9516?
A9516 is a HCPCS Level II code for iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A9516?
The CMS HCPCS file marks A9516 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is A9516 paid under the physician fee schedule?
A9516 carries PFS status code C. Contractor-priced. Your MAC establishes the RVUs and the payment amount case by case, usually after reviewing documentation. There is no national amount to compute.