Does A9596 require prior authorization?

Yes, A9596 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for A9596?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation may be required to support requests for imaging; the documentation must reflect the clinical situation and document the ordering clinician’s intent.

Advanced imaging is medically necessary for diagnostic workup, management, and surveillance of documented primary CNS cancer.
Annual MRI breast screening indicated for individuals who received chest radiation between ages 10 and 30.
Annual MRI breast screening indicated for individuals with BRCA1 or BRCA2 mutations.
Annual MRI breast imaging indicated for individuals with extremely dense breast tissue aged 50 or older.
Annual MRI breast screening indicated for individuals with lifetime breast cancer risk ≥20% as defined by specified models.
Screening CT colonography indicated for average-risk individuals as an alternative to conventional colonoscopy at 5-year intervals, starting at age 45.

CARELON-oncologic-imaging-2025-11-15, Oncologic Imaging

CARELON-oncologic-imaging-2026-04-04, Oncologic Imaging

EVICORE-HPLAN-CIGNA_MEDICARE-68F4526A04BF, 1199SEIU Radiology and Cardiology Claims Studio Code List - Effective 01/01/2026

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