A9504, Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries
HCPCS/CPT
Prior Authorization
Prior Auth Required
Code explicitly requires prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- None specified in this Clinical Policy Bulletin.
Key Coverage Criteria
- None — Aetna considers AcuTect scintigraphic imaging for detection and localization of deep vein thrombosis (DVT) in the lower extremity experimental and investigational and therefore not covered.
2 Active Policies
AETNA-CPB-0414, AcuTect Scintigraphic Imaging for Detection of Lower Limb Deep Vein Thrombosis
EVICORE-HPLAN-CIGNA_MEDICARE-68F4526A04BF, 1199SEIU Radiology and Cardiology Claims Studio Code List - Effective 01/01/2026
Related Codes
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