A9513 HCPCS - LUTETIUM LU 177, DOTATATE, THERAPEUTIC, 1 MILLICURIE

Code Information

HCPCS Code: A9513
Sequence Number: 0010
Short Description: Lutetium lu 177 dotatat ther
Long Description: Lutetium lu 177, dotatate, therapeutic, 1 millicurie
Date Added: 1/1/2019
Action Code: N - No maintenance for this code
Action Effective Date: 1/1/2024
Classification: Transportation, Medical & Surgical Supplies, Miscellaneous & Experimental
Coding System: HCPCS

Pricing Indicator Code:
- 57 - Other carrier priced
Multiple Pricing Indicator Code: A - Not applicable as HCPCS priced under one methodology
Coverage Issues Manual Reference Section Number:
- 153.60
Medicare Carriers Manual Reference Section Number:
N/A
Coverage Code: D - Special coverage instructions apply

Field Name	Field Value
Healthcare Common Procedure Coding System Code	A9513
HCPCS Sequence Number	0010
HCPCS Record Identification Code	3 - First line of procedure record also contains detail information in positions 92-275
HCPCS Long Description	Lutetium lu 177, dotatate, therapeutic, 1 millicurie
HCPCS Short Description	Lutetium lu 177 dotatat ther
HCPCS Pricing Indicator Code 1	57 - Other carrier priced
HCPCS Multiple Pricing Indicator Code	A - Not applicable as HCPCS priced under one methodology
HCPCS Coverage Issues Manual Reference Section Number 1	153.60
HCPCS Coverage Code	D - Special coverage instructions apply
HCPCS Berenson-Eggers Type Of Service Code	I1E - Standard imaging - nuclear medicine
HCPCS Type Of Service Code 1	6 - Therapeutic radiology
HCPCS Anesthesia Base Unit Quantity	0
HCPCS Code Added Date	1/1/2019
HCPCS Action Effective Date	1/1/2024
HCPCS Action Code	N - No maintenance for this code