Home › Drug Codes › A Codes › A9575 · CLARISCAN
Updated July 1st, 2026

CLARISCAN A Code: A9575

Injection, gadoterate meglumine, 0.1 ml

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Q4 2026 Medicare Payment Limit for A9575, effective October 1, 2026: $0.105 per HCPCS billing unit, up 16.7% from $0.09. From CMS's final file.

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Medicare Payment Limit ?
$0.09
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
Not published
CMS publishes none for Q3 2026
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
34
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Drug & Product Overview

HCPCS Descriptor Injection, gadoterate meglumine, 0.1 ml
HCPCS Added Date January 1, 2014
Manufacturer Multiple Manufacturers
Route of Administration Intravenous
Generic Status Multi-Source; Generic
Dosage Type Single-Dose
Dosage Form Injection | Injection, Solution

About CLARISCAN

Clariscan is a medication aligned to the HCPCS A Code: A9575 for billing, pricing, and reimbursement purposes in the United States. Classified under Imaging/Radiopharmaceutical, it is administered via the intravenous route and manufactured by multiple companies.

According to CMS Drug Use Information: This medication is used before a magnetic resonance imaging (MRI) scan. It belongs to a class of drugs known as gadolinium-based contrast agents (GBCAs). This medication helps the MRI scan make clearer images, so your doctor can more easily diagnose your condition.

Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.

NDC Code Information

Based on publicly available CMS files. Showing 5 of 34 NDCs — log in for the full crosswalk.

NDC Code Drug Manufacturer Billing Units / Pkg Package Size
00407-2943-01 Clariscan Ge Healthcare 1000 3769 MG / 10 ML
00407-2943-02 Clariscan Ge Healthcare 1500 5653.5 MG / 15 ML
65219-0080-05 Gadoterate Meglumine Fresenius Kabi USA, LLC 500 1884.5 MG / 5 ML
67684-2000-00 Dotarem Guerbet LLC 500 1884.5 MG / 5 ML
70436-0123-31 gadoterate meglumine Slate Run Pharmaceuticals, LLC 500 1884.5 MG / 5 ML
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CLARISCAN Pricing & Reimbursement

A9575 Private Payer Reimbursement
$0.30 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

Create an account on PayerPrice for more information →
UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

Historical Graphing and Billing Calculator

per HCPCS unit
As of Q3 2026

CLARISCAN CPT Administration Codes

The below list of CPT codes is intended for informational purposes only and may not be exhaustive. CPT® codes and descriptions are copyright American Medical Association (AMA). All rights reserved.

CPT Code Description
96374 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug), IV push, single, or initial substance/drug
96375 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug.
Not on the CMS JW / JZ list

CMS does not include Clariscan (A9575) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing A9575. Wastage billing guide →

CLARISCAN Medically Unlikely Edits (MUE)

The most billing units of A9575 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 0.1 ml.

Practitioner Office & Hospital Outpatient
300 units / day
= 30 ml per day

MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →

ml Enter a dose to see how many billing units it is and whether it is under the limit.

CLARISCAN Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.

Brain (intracranial), spine and associated tissues MRI Brain (intracranial), spine and associated tissues MRI contrast enhancement Brain (intracranial), spine and associated tissues MRI enhancement
Drug Class
Gadolinium-based Contrast Agent [EPC]Magnetic Resonance Contrast Activity [MoA]

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Frequently Asked Questions

Is there an available Clariscan billing and coding guide?
Our team has not identified a manufacturer-published source of billing and coding information for CLARISCAN.
Are there any available Clariscan patient assistance programs?
Our team has not identified a manufacturer-published source of patient assistance information for CLARISCAN.
Where can I find Clariscan prescribing information?
CLARISCAN prescribing information can be found at the link below. Please reach out to us if you believe this information to be innacurate or out of date. Visit Here →
Where can I find Clariscan side effect information?
Our team has not yet identified a source of side effects information for CLARISCAN. Please check back in a few weeks.
Does billing CLARISCAN require JZ/JW wastage modifiers?
CMS does not include CLARISCAN (A9575) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing A9575. For more information, visit the link below.

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