How To Use HCPCS Code A9607

HCPCS code A9607 describes the therapeutic use of Lutetium lu 177 vipivotide tetraxetan. This article will provide a comprehensive overview of this specific HCPCS code, including its official description, procedure details, when to use the code, billing guidelines, historical information, Medicare and insurance coverage, and examples of when this code should be billed.

1. What is HCPCS A9607?

HCPCS code A9607 is used to identify the therapeutic use of Lutetium lu 177 vipivotide tetraxetan. This code specifically represents the administration of 1 millicurie of this therapeutic substance. It is important to note that HCPCS codes are used for billing and reporting purposes in the healthcare industry.

2. Official Description

The official description of HCPCS code A9607 is “Lutetium lu 177 vipivotide tetraxetan, therapeutic, 1 millicurie.” This description accurately reflects the specific therapeutic substance and the quantity administered.

3. Procedure

1. The procedure for administering Lutetium lu 177 vipivotide tetraxetan involves several steps:

• Patient preparation: The patient’s medical history and condition are assessed to determine their eligibility for this therapeutic treatment.
• Radiopharmaceutical preparation: The Lutetium lu 177 vipivotide tetraxetan is prepared according to the manufacturer’s instructions.
• Injection administration: The prepared radiopharmaceutical is injected into the patient’s body, typically through a vein.
• Monitoring and observation: The patient is closely monitored for any adverse reactions or side effects during and after the administration of the therapeutic substance.

4. When to use HCPCS code A9607

HCPCS code A9607 should be used when a healthcare provider administers Lutetium lu 177 vipivotide tetraxetan for therapeutic purposes. This code is typically used in the context of treating specific medical conditions or diseases where this therapeutic substance has been proven to be effective. It is important to follow any specific eligibility criteria or guidelines provided by the payer or regulatory authorities when using this code.

5. Billing Guidelines and Documentation Requirements

When billing for the administration of Lutetium lu 177 vipivotide tetraxetan using HCPCS code A9607, healthcare providers need to ensure accurate and complete documentation. This documentation should include details such as the patient’s medical history, the specific condition being treated, the dosage administered, and any relevant supporting documentation or test results. It is important to follow the billing guidelines provided by the payer to ensure proper reimbursement for the service.

6. Historical Information and Code Maintenance

HCPCS code A9607 was added to the Healthcare Common Procedure Coding System on October 01, 2022. As of the effective date, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code is relatively new and does not have a significant historical context or any notable changes since its addition.

7. Medicare and Insurance Coverage

The coverage and pricing of HCPCS code A9607 may vary depending on the payer, including Medicare and other insurance providers. The pricing indicator code 57 indicates that this code is priced by other carriers, and the multiple pricing indicator code A signifies that it is not applicable as HCPCS priced under one methodology. It is important to verify the coverage and reimbursement policies of the specific payer to determine the payment for this service or supply.

8. Examples

Here are five examples of when HCPCS code A9607 should be billed:

1. A patient diagnosed with neuroendocrine tumors receives Lutetium lu 177 vipivotide tetraxetan therapy as part of their treatment plan.
2. A healthcare provider administers Lutetium lu 177 vipivotide tetraxetan to a patient with inoperable prostate cancer to target and destroy cancer cells.
3. A patient with metastatic somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors undergoes Lutetium lu 177 vipivotide tetraxetan therapy to manage their condition.
4. A healthcare facility offers Lutetium lu 177 vipivotide tetraxetan therapy as a treatment option for patients with advanced neuroendocrine tumors.
5. A patient with progressive metastatic castration-resistant prostate cancer receives Lutetium lu 177 vipivotide tetraxetan therapy to slow down the progression of the disease.