HCPCS code A9516: Iodine-123 sodium iodide, per 100 microcuries2026 Medicare rate & RVUs in Illinois
Reports diagnostic iodine-123 sodium iodide used for thyroid uptake measurement or imaging, in units representing 100 microcuries each.
CMS doesn’t publish an office rate for A9516 in Illinois.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 9 sections
What A9516 covers
Iodine-123 sodium iodide is a diagnostic radiopharmaceutical taken up by thyroid tissue. Nuclear medicine teams typically administer it orally before measuring thyroid uptake or obtaining thyroid images, such as during evaluation of thyroid function or anatomy. The radiopharmaceutical supply is distinct from the uptake measurement or imaging service performed and interpreted by the nuclear medicine team.
Medicare assigns this HCPCS Level II code carrier-priced status: CMS publishes no national physician fee schedule payment, and the Medicare contractor sets payment for the claim. CMS classifies its pricing as other contractor pricing and leaves coverage to the contractor’s judgment. One unit represents 100 microcuries; report units based on the administered activity, subject to the code’s limit of 999 microcuries. For example, 300 microcuries is 3 units.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where A9516 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | Unavailable | Unavailable |
| East St. Louis, IL | Unavailable | Unavailable |
| Rest of Illinois | Unavailable | Unavailable |
| Suburban Chicago, IL | Unavailable | Unavailable |
How the A9516 rate is calculated
Each of A9516’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · A9516
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for A9516
A9516 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · A9516
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
—
A9516 isn’t priced in this setting.
A9516 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- A9509Iodine I-123Per millicurie
- A9509 is another code for diagnostic iodine-123 sodium iodide, but uses a different dose basis. Select between the codes according to the dose and applicable code unit.
- A9528Iodine-131 capsuleDiagnostic, per millicurie
- A9528 identifies diagnostic iodine-131 iodide, not iodine-123 sodium iodide. The radionuclide and radiopharmaceutical are different.
- A9517I-131 capsuleTherapeutic, per millicurie
- A9517 identifies therapeutic iodine-131 iodide. A9516 is for diagnostic iodine-123 sodium iodide, not radioiodine therapy.
A9516 billing questions
How many units should be reported?
Each unit represents 100 microcuries. Report the administered activity in 100-microcurie units; 300 microcuries equals 3 units.
When should A9516 be chosen over A9509?
Both codes identify diagnostic iodine-123 sodium iodide, but A9516 is the per-100-microcurie code for doses up to 999 microcuries. Use the code whose dose basis matches the radiopharmaceutical amount.
Does A9516 describe the thyroid imaging service?
No. A9516 identifies the radiopharmaceutical supply. Thyroid uptake measurement or imaging is represented by its own service code when performed.
How does Medicare price and cover A9516?
It is carrier priced, with no national physician fee schedule payment; the Medicare contractor sets payment for the claim. Coverage is left to the contractor’s judgment.
What should the record support?
Document the iodine-123 sodium iodide administered and its activity in microcuries so the billed units can be tied to the dose.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Fee sheets · Coming soon
Put A9516 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist