How much does Medicare pay for HCPCS A9538?

Medicare allowed an average of $63.52 per service and paid $50.51 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $252.58, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code A9538?

Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries. It was billed 1,135 times to 1,131 Medicare beneficiaries by 53 providers in 2024.

Which specialty bills A9538 most?

Cardiology, with 737 services from 32 clinicians. Next are Diagnostic Radiology, Nuclear Medicine, Interventional Cardiology.

HCPCS A9538

Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries

$63.52Medicare-allowed amount per service, averaged across 1,135 services

Providers submitted

$252.58

Asking price, not received

Medicare allowed

$63.52

The fee schedule figure

Medicare paid

$50.51

Balance is patient coinsurance

Providers submitted an average of $252.58 for this code and Medicare allowed $63.52 — 4.0× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $50.51 (80%); the rest is the patient’s coinsurance and deductible.

Services: 1,135
Beneficiaries: 1,131
Providers billing it: 53
Total allowed: $72,095

What Medicare pays for HCPCS A9538

Across 1,135 services billed by 53 providers to 1,131 beneficiaries, Medicare allowed an average of $63.52 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills A9538

Specialty	Services	Beneficiaries	Avg allowed	Providers
Cardiology	737	734	$67.04	32
Diagnostic Radiology	183	183	$55.87	9
Nuclear Medicine	115	115	$64.45	6
Interventional Cardiology	63	63	$48.12	4
Internal Medicine	25	24	$67.71	1
Independent Diagnostic Testing Facility (IDTF)	12	12	$27.00	1

A9538 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	377	$69.65	$55.30	13
Florida	188	$64.02	$50.78	10
New York	118	$27.85	$21.50	7
New Jersey	82	$90.31	$71.96	5
Washington	70	$67.66	$54.95	2
Arizona	50	$67.78	$53.97	3
Massachusetts	41	$24.25	$19.05	2
Maryland	38	$99.67	$80.99	2
Nevada	36	$65.97	$54.59	2
Idaho	30	$71.85	$57.25	1
Kansas	25	$71.85	$57.25	1
Ohio	22	$24.32	$18.48	1
Pennsylvania	20	$117.00	$93.22	1
Delaware	13	$35.42	$28.22	1
Alabama	13	$16.58	$12.71	1
Illinois	12	$27.00	$21.51	1

Related codes

A9575Injection, gadoterate meglumine, 0.1 ml$0.12
A9585Injection, gadobutrol, 0.1 ml$0.31
A9579Injection, gadolinium-based magnetic resonance contrast agent, not oth$1.47
A9500Technetium tc-99m sestamibi$110.81
A9502Technetium tc-99m tetrofosmin$181.87
A9577Injection, gadobenate dimeglumine (multihance), per ml$1.72
A9555Rubidium rb-82$526.83
A9552Fluorodeoxyglucose f-18 fdg$321.77
A9576Injection, gadoteridol, (prohance multipack), per ml$1.46
A9595Piflufolastat f-18$626.38
A9573Injection, gadopiclenol, 1 ml$5.15
A9578Injection, gadobenate dimeglumine (multihance multipack), per ml$1.74

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.