A9569 — Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose
A9569 is a HCPCS Level II code for technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose. 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 A9569 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
- 1 unit MAI 3 — Date of Service Edit: Clinical · Code Descriptor / CPT Instruction
- outpatient
- 1 unit MAI 3 — Date of Service Edit: Clinical · Code Descriptor / CPT Instruction
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 A9569
- Long descriptor
- Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose
- Short descriptor
- Technetium tc-99m auto wbc
- Added
- January 1, 2008
- 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 A9569
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A9569 is not quite right, the correct code is very often within a few positions of it.
- A9560Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries
- A9561Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries
- A9562Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries
- A9563Sodium phosphate p-32, therapeutic, per millicurie
- A9564Chromic phosphate p-32 suspension, therapeutic, per millicurie
- A9566Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries
- A9567Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries
- A9568Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries
- A9570Indium in-111 labeled autologous white blood cells, diagnostic, per study dose
- A9571Indium in-111 labeled autologous platelets, diagnostic, per study dose
- A9572Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries
- A9573Injection, gadopiclenol, 1 ml
- A9574Injection, ferumoxytol, 1 mg
- A9575Injection, gadoterate meglumine, 0.1 ml
- A9576Injection, gadoteridol, (prohance multipack), per ml
- A9577Injection, gadobenate dimeglumine (multihance), per ml
Questions about A9569
What is HCPCS code A9569?
A9569 is a HCPCS Level II code for technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A9569?
The CMS HCPCS file marks A9569 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 A9569 paid under the physician fee schedule?
A9569 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.