A9576 — Injection, gadoteridol, (prohance multipack), per ml
A9576 is a HCPCS Level II code for injection, gadoteridol, (prohance multipack), per ml. 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 A9576 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
- 100 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- outpatient
- 100 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
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 A9576
- Long descriptor
- Injection, gadoteridol, (prohance multipack), per ml
- Short descriptor
- Inj prohance multipack
- Added
- January 1, 2008
- 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 A9576
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A9576 is not quite right, the correct code is very often within a few positions of it.
- A9568Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries
- A9569Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose
- 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
- A9577Injection, gadobenate dimeglumine (multihance), per ml
- A9578Injection, gadobenate dimeglumine (multihance multipack), per ml
- A9579Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml
- A9580Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries
- A9581Injection, gadoxetate disodium, 1 ml
- A9582Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries
- A9583Injection, gadofosveset trisodium, 1 ml
- A9584Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries
Questions about A9576
What is HCPCS code A9576?
A9576 is a HCPCS Level II code for injection, gadoteridol, (prohance multipack), per ml. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A9576?
The CMS HCPCS file marks A9576 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 A9576 paid under the physician fee schedule?
A9576 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.