Radium ra 223 dichloride intravenous route description and. It attempts to optimize patients selection for the best outcome from therapy with ra223 xofigo. A9606 hcpcs code radium ra223 dichloride ther hcpcs. Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each. Objectives radium223 dichloride xofigo has been approved in the us for treatment of bony metastases from castrate refractory prostate cancer crpc. Billing for xofigo radium ra 223 dichloride injection and. Radium ra223 dichloride, therapeutic, per microcurie a9606. It was first approved by the fda in may 20 and is currently marketed under the brand name. For these services, please use healthtap prime or healthtap concierge. Radium ra 223 dichloride xofigo, also known as radium223, is an alpha particleemitting radiotherapeutic agent. Based on the guidelines of our revised medical policy, radium ra 223 dichloride xofigo and the submitted diagnosis codes.
Radium223 dichloride xofigo, bayer healthcare pharmaceuticals inc. J0295 3 injection baclofen, 50mcg intrathecaltrial codes. The hcpcs codes range other orthopedic footwear l3215l3265 is a standardized code set necessary for medicare and other health insurance providers to provide healthcare claims. Godlewski, a polish chemist from krakow, and is historically known as actinium x, or acx. Apr 02, 2015 exploratory study of radium 223 and vegftargeted therapy in patients with metastatic renal cell carcinoma and bone mets the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. We offer innovative kansas health insurance coverage, caring customer service, and a full range of health and wellness initiatives for individuals and businesses. It is for men whose prostate cancer has spread to the bone with symptoms but not to other parts of the body. Stacy schmidt 61215 chapter 3 homework 1 hcpcs level ii contains codes for drugs that are administered. Department of health and human services centers for medicare. Radium223 dichloride longterm followup program full. Cpt hcpcs procedure code changes for january 2017 surgery, medicine, radiology, and evaluation and management services status code.
A9606 radium ra223 dichloride, therapeutic, per microcurie. Radiopharmaceuticals and contrast media page 2 of 7 unitedhealthcare oxford clinical policy effective 05012018 19962018, oxford health plans, llc benefit considerations before using this policy, please check the member specific benefit plan document and any federal or state mandates, if applicable. The hcpcs codes listed in table 2, below, are new for 2016 and are subject to clia edits. Description a modifier enables a provider to report that a. Radium ra 223 dichloride is a radiopharmaceutical containing the radioisotope radium 223 that emits short range but high linear energy alpha particles. Providers should not indicate healthcare common procedure coding system hcpcs procedure code j3490 unclassified drugs when submitting claims to wisconsin medicaid for synagis claims submitted for synagis with hcpcs procedure code j3490 will be denied.
Memorandum decision and order granting in part and denying in part defendant s motion for partial stay docket no. In a freestanding center or hospital outpatient setting, xofigo is reported using the productspecific hcpcs acode, a9606 radium ra 223 dichloride, therapeutic, per microcurie. Hcpcs a9606 radium ra223 dichloride, therapeutic, per microcurie hcpcs a9699 radiopharmaceutical, therapeutic, not otherwise classified 1 twodigit numeric codes are level i code modifiers ed by the american medical associations current procedural terminology cpt. View coding information for xofigo radium ra 223 dichloride injection, including hcpcs, cpt, and icd10 codes, and helpful resources. Hcpcs code c9399 must be used for radium 223 submitted on a ub 04. October 2008 revisions to ioce data files, instructions, and specifications are provided in. Exploratory study of radium223 and vegftargeted therapy in. Listing a study does not mean it has been evaluated by the u. Coding for xofigo xofigo radium ra 223 dichloride for hcps. Transportation of portable xray equipment and personnel to home or nursing home, per trip to facility or location, more than one patient seen. Short description radium ra223 dichloride ther hcpcs coverage code. Optimizing patient selection for therapy with radium 223.
Radium ra223 dichloride, therapeutic, per microcurie. Radium223 dichloride longterm followup program the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Exploratory study of radium223 and vegftargeted therapy. Services represented are subject to provisions of the health plan including, but not limited to, membership eligibility, premium payment, claim payment logic, provider contract terms. List of the 1 ndc products with the active ingredient radium ra 223 dichloride. Radium ra 223 dichloride xofigo wellmark blue cross and blue. The hcpcs codes listed below require a facility to have either a. Radium223 injection mimics calcium and forms complexes with the bone mineral. To report provider services, use appropriate cpt codes, alpha numeric.
It is used in patients whose disease has metastasized spread to the bones and is causing symptoms but has not spread to other organs. Radium223 dichloride longterm followup program full text. Hcpcs code a9606 for radium ra223 dichloride, therapeutic, per microcurie as maintained by cms falls under diagnostic and therapeutic radiopharmaceut. Exploratory study of radium223 and vegftargeted therapy in patients with metastatic renal cell carcinoma and bone mets the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Billing for hospital outpatient settings xofigo radium ra. Variances in reimbursement may occur due to rounding calculations. Cms has assigned a productspecific hcpcs code for xofigo, a9606 radium ra 223 dichloride, therapeutic, per microcurie, effective january. Prostate cancer that is castration resistant has not responded to treatments that lower testosterone levels. Description a modifier enables a provider to report that a service or procedure has been altered by some. A9606 hcpcs code descriptors radium ra223 dichloride, therapeutic, per microcurie. Chapter 3 homework stacy schmidt chapter 3 homework 1 hcpcs. New productspecific hcpcs code, a9606, radium ra223 dichloride, therapeutic, per microcurie close. Although the update refers to medicaid recipients, all. New productspecific hcpcs code, a9606, radium ra 223 dichloride, therapeutic, per microcurie close.
Since physicians should not report drug administration. Radium223 dichloride radium223, an alpha emitter, selectively targets bone metastases with alpha particles. Code editor ioce and opps pricer will reflect the healthcare common procedure coding system hcpcs, ambulatory payment classification apc, hcpcs modifier, and revenue code additions, changes, and deletions identified in cr 6196. Clia certificate of registration certificate type code 9. Hcpcs code a9606 submitted on claims for services provided on and after october 17, 2016 to male patients regardless of patient age may be denied as an investigational service. Radium ra223 dichloride, therapeutic, per microcurie hcpcs code a9606 for radium ra223 dichloride, therapeutic, per microcurie as maintained by cms falls under diagnostic and therapeutic radiopharmaceuticals. J0585 x 2 or j0585 j0585 5 injection dilaudid, 2 mg code. It is acceptable to bill either cpt code 77750 or 79101 for this procedure. Provider requirements and medicare notices 15 icd10cm.
L3929 hcpcs code descriptors hand finger orthosis hfo, includes one or more nontorsion joints, turnbuckles, elastic bandssprings, may include soft. Transportation of portable xray equipment and personnel to home or nursing home, per trip to facility or location, one patient seen hcpcs code. Coding verification will be required for both prefabricated and. Subscribe to aapc coder and get the code details in a flash.
Use radium ra 223 dichloride as ordered by your doctor. Sample cms1500 claim form version 0212 as of april 2014. A9606 hcpcs code radium ra223 dichloride, therapeutic, per. Blue cross and blue shield of kansas is the largest health insurer in the state of kansas. Age restrictions children must be under 24 months of age to begin receiving the drug. L3929 hcpcs code hand finger orthosis hfo, includes. Xofigo radium ra 223 dichloride injection is used to treat prostate cancer that no longer responds to hormonal or surgical treatment that lowers testosterone. The list does not include new hcpcs codes for waived tests or providerperformed procedures. N no maintenance for this code hcpcs action effective date. May 01, 2016 objectives radium223 dichloride xofigo has been approved in the us for treatment of bony metastases from castrate refractory prostate cancer crpc. Please note that individual medicare administrative contractors macs, private payors, or other payors or claims processors may have different coding requirements. Icd10 for atrial fibrillation and flutter 16 new dsnp plans offered in 2015.
As of 20, this field contains the consumer friendly descriptions for the ama cpt codes. Hcpcs codes and charges for these internal and external device components is necessary so that the opps payment for the associated procedures will be correct in future years in which the claims are used to set the apc payment rates. Radium223 dichloride american society for radiation oncology. The discontinued code is not valid for billing dates of service after 123105. This study describes our experience in patients treated with ra223 xofigo. Recent post hoc analyses of the phase iii alsympca trial support the previously. A9606, radium ra223 dichloride, therapeutic, per microcurie, aapc coder, hcpcs codes. Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each. Laboratory 2006 hcpcs changes effective for dates of service on or after 1106, refer to the crossreference procedure code for billing. Radium ra 223 dichloride injection is used to treat men with. Radium223 dichloride is an alpha particleemitting radiotherapy drug that mimics. Drink lots of noncaffeine liquids unless told to drink less liquid by your doctor. Xofigo 1100 kbqml injektionslosung patienteninfoservice.
As a cation, radium mimics calicum and binds to hydroxyapatite, which is a bone mineral found in areas of high bone turnover as seen in bone metastases. Cpthcpcs procedure code changes for january 2017 surgery, medicine, radiology, and evaluation and management services status code. A9606 hcpcs code descriptors radium ra 223 dichloride, therapeutic, per microcurie. Radiopharmaceuticals and contrast media page 2 of 7 unitedhealthcare oxford clinical policy effective 05012018 19962018, oxford health plans, llc benefit considerations before using this policy, please check the member specific benefit plan document and. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Other orthopedic footwear l3215l3265 hcpcs codes aapc. Tlso and lso policy article effective july 2010 published march 11, 2010 contains revised coding guidelines requiring certain products to be evaluated by the pricing, data analysis, and coding pdac contractor for proper coding. Xofigo radium223 medical clinical policy bulletins aetna. Billing for hospital outpatient settings xofigo radium. How is this medicine radium ra 223 dichloride best taken. Corporate reimbursement policy an independent licensee of the blue cross and blue shield association modifier guidelines file name.
Cpt code from surgery section must be used to indicate the injection and hcpcs level ii code is reported for the contrast substance, such as a4641 if descriptions state radiologic supervision and interpretation alert you to. Healthtap does not provide medical advice, diagnosis, or treatment. Cms has assigned a productspecific hcpcs code for xofigo, a9606 radium ra223 dichloride, therapeutic, per microcurie, effective january. Check out these bestsellers and special offers on books and newsletters from. Aetna considers xofigo radium ra223 dichloride medically necessary for the treatment of men with symptomatic, metastatic, castrationresistant prostate. Please note that individual medicare administrative contractors macs, private payors, or other payors or claims processors may have different coding requirements for radiopharmaceuticals in the freestanding center. Radium223 therapy for patients with metastatic castrate. Radium ra 223 dichloride is a radiopharmaceutical containing the radioisotope radium223 that emits short range but high linear energy alpha particles. Radium ra 223 dichloride, therapeutic, per microcurie. Other orthopedic footwear l3215l3265 hcpcs codes aapc coder. Radium223 223 ra, ra 223 was discovered in 1905 by t. The use of radium ra223 dichloride xofigo for breast cancer and for use in. Radium223 is a calcium mimetic that preferentially targets bone metastases with highenergy. Xofigo radium ra 223 dichloride injection is available in singleuse vials containing 6 ml of solution at a concentration of 1,100 kbqml 30 microcurieml at the reference date with a total radioactivity of 6,600 kbqvial 178 microcurievial at the reference date.
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