A9576, Injection, gadoteridol, (prohance multipack), per ml
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
1 Active Policy
EVICORE-HPLAN-CIGNA_MEDICARE-68F4526A04BF, 1199SEIU Radiology and Cardiology Claims Studio Code List - Effective 01/01/2026
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.