Home › Drug Codes › A Codes › A9576 · PROHANCE MULTIPACK
Updated July 1st, 2026

PROHANCE MULTIPACK A Code: A9576

Injection, gadoteridol, (prohance multipack), per ml

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Q4 2026 Medicare Payment Limit for A9576, effective October 1, 2026: $1.345 per HCPCS billing unit, down 1.8% from $1.369. From CMS's final file.

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Medicare Payment Limit ?
$1.369
/ 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 ?
1
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Drug & Product Overview

HCPCS Descriptor Injection, gadoteridol, (prohance multipack), per ml
HCPCS Added Date January 1, 2008
Manufacturer Bracco Diagnostics Inc
Route of Administration Intravenous
Generic Status Single-Source; Branded
Dosage Type Multi-Dose
Dosage Form Injection, Solution

About PROHANCE MULTIPACK

Prohance Multipack is a medication aligned to the HCPCS A Code: A9576 for billing, pricing, and reimbursement purposes in the United States. This Imaging/Radiopharmaceutical medication is administered via the intravenous route and manufactured by Bracco Diagnostics Inc.

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. The list of NDCs below is not exhaustive.

NDC Code Drug Manufacturer Billing Units / Pkg Package Size
00270-1111-70 ProHance Bracco Diagnostics Inc 250 13965 MG / 50 ML
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PROHANCE MULTIPACK Pricing & Reimbursement

A9576 Private Payer Reimbursement
$1.33 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

Historical Graphing and Billing Calculator

per HCPCS unit
As of Q3 2026

PROHANCE MULTIPACK 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 Prohance Multipack (A9576) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing A9576. Wastage billing guide →

PROHANCE MULTIPACK Medically Unlikely Edits (MUE)

The most billing units of A9576 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 ml.

Practitioner Office & Hospital Outpatient
100 units / day
= 100 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.

PROHANCE MULTIPACK 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.

MRI of Extracranial/Extraspinal Tissues MRI of the Central Nervous System (CNS)
Drug Class
Magnetic Resonance Contrast Activity [MoA]Paramagnetic Contrast Agent [EPC]

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Frequently Asked Questions

Is there an available Prohance Multipack billing and coding guide?
Billing and coding information for PROHANCE MULTIPACK can be found through Bracco Diagnostics. Visit Here →
Are there any available Prohance Multipack patient assistance programs?
Our team has not identified a manufacturer-published source of patient assistance information for PROHANCE MULTIPACK.
Where can I find Prohance Multipack prescribing information?
PROHANCE MULTIPACK prescribing information can be found at the link below: Visit Here →
Where can I find Prohance Multipack side effect information?
Our team has not yet identified a source of side effects information for PROHANCE MULTIPACK. Please check back in a few weeks.
Does billing PROHANCE MULTIPACK require JZ/JW wastage modifiers?
CMS does not include PROHANCE MULTIPACK (A9576) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing A9576. For more information, visit the link below.

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