How To Use HCPCS Code A9606

HCPCS code A9606 describes the therapeutic use of radium ra-223 dichloride per microcurie. This code is used to identify and bill for the administration of this specific radioactive substance for therapeutic purposes. In this article, we will explore the details of HCPCS code A9606, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS A9606?

HCPCS code A9606 is used to identify the therapeutic use of radium ra-223 dichloride per microcurie. This code specifically refers to the administration of this radioactive substance for therapeutic purposes. It is important to note that this code is not applicable for other uses or substances.

2. Official Description

The official description of HCPCS code A9606 is “Radium ra-223 dichloride, therapeutic, per microcurie.” This description accurately reflects the purpose and nature of the code. The short description for this code is “Radium ra223 dichloride ther.”

3. Procedure

1. The procedure for HCPCS code A9606 involves the administration of radium ra-223 dichloride per microcurie. The provider must follow specific guidelines and safety protocols for handling and administering this radioactive substance.
2. The administration may involve intravenous infusion or injection, depending on the specific treatment plan and patient’s condition.
3. Proper documentation of the procedure, including the dosage administered and any relevant patient information, is essential for accurate billing and reimbursement.

4. When to use HCPCS code A9606

HCPCS code A9606 should be used when the provider administers radium ra-223 dichloride per microcurie for therapeutic purposes. This code is specifically for the therapeutic use of this radioactive substance and should not be used for other purposes or substances.

It is important to review any specific eligibility criteria or guidelines provided by payers or regulatory bodies to ensure proper usage of this code. Providers should also consider the patient’s medical condition and treatment plan when determining the appropriateness of using HCPCS code A9606.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9606, healthcare providers need to ensure accurate documentation and adherence to billing guidelines. Here are some key considerations:

• Document the dosage of radium ra-223 dichloride administered per microcurie.
• Include relevant patient information, such as medical history and treatment plan.
• Submit the claim with the appropriate supporting documentation to ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code A9606 was added to the Healthcare Common Procedure Coding System on January 01, 2015. As of the effective date of January 01, 2018, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

It is important to stay updated with any changes or revisions to HCPCS code A9606, as well as any historical context related to its addition or termination, if applicable.

7. Medicare and Insurance Coverage

The coverage and pricing of HCPCS code A9606 may vary depending on the payer, including Medicare and other insurance providers. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers.

It is advisable to review the specific coverage policies and guidelines of the payer to determine the reimbursement and pricing details for HCPCS code A9606.

8. Examples

Here are five examples of scenarios where HCPCS code A9606 should be billed:

1. A patient with metastatic prostate cancer receives radium ra-223 dichloride therapy at a healthcare facility.
2. A physician administers radium ra-223 dichloride per microcurie to a patient with bone metastases from a primary cancer.
3. A patient undergoes radium ra-223 dichloride therapy as part of a clinical trial for advanced cancer treatment.
4. A healthcare provider administers radium ra-223 dichloride therapy to a patient with symptomatic bone metastases.
5. A patient with castration-resistant prostate cancer receives radium ra-223 dichloride therapy to alleviate pain and improve quality of life.