A9603 — Injection, pafolacianine, 0.1 mg
A9603 is a HCPCS Level II code for injection, pafolacianine, 0.1 mg. 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 statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
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 A9603 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
- 64 units MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 64 units MAI 3 — Date of Service Edit: Clinical · CMS Policy
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 A9603
- Long descriptor
- Injection, pafolacianine, 0.1 mg
- Short descriptor
- Inj, pafolacianine, 0.1 mg
- Added
- October 1, 2023
- BETOS
- I1E
- Pricing indicator
- 51 — 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.
Drugs.
Codes adjacent to A9603
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A9603 is not quite right, the correct code is very often within a few positions of it.
- A9595Piflufolastat f-18, diagnostic, 1 millicurie
- A9596Gallium ga-68 gozetotide, diagnostic, (illuccix), 1 millicurie
- A9597Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified
- A9598Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified
- A9599Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose, not otherwise specifiedterminated
- A9600Strontium sr-89 chloride, therapeutic, per millicurie
- A9601Flortaucipir f 18 injection, diagnostic, 1 millicurie
- A9602Fluorodopa f-18, diagnostic, per millicurie
- A9604Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries
- A9606Radium ra-223 dichloride, therapeutic, per microcurie
- A9607Lutetium lu 177 vipivotide tetraxetan, therapeutic, 1 millicurie
- A9608Flotufolastat f 18, diagnostic, 1 millicurie
- A9609Fludeoxyglucose f18 up to 15 millicuries
- A9610Xenon xe-129 hyperpolarized gas, diagnostic, per study dose
- A9611Flurpiridaz f 18, diagnostic, 1 millicurie
- A9612Injection, fluorescein, 1 mg
Questions about A9603
What is HCPCS code A9603?
A9603 is a HCPCS Level II code for injection, pafolacianine, 0.1 mg. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A9603?
The CMS HCPCS file marks A9603 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 A9603 paid under the physician fee schedule?
A9603 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.