0000016465 00000 n PYLARIFY PATIENT BROCHURE The PYLARIFY patient brochure includes information on prostate cancer, an overview of how PYLARIFY can help you and your doctor create an optimal treatment plan, as well as what to expect when having a PET/CT scan. No fee schedules, basic unit, relative values or related listings are included in CPT. A9542 Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries. The second trial enrolled 208 patients who had rising serum PSA levels after initial prostate surgery or other definitive therapy, and thus had biochemical evidence of recurrent prostate cancer. PSMA is approved for patients who have undergone definitive therapy and have a rising PSA or those with high-risk prostate cancer. PYLARIFY (piflufolastat F 18) Injection is a radioactive diagnostic agent indicated for positron emission tomography (PET) of prostate-specific membrane antigen (PSMA) positive lesions in men with prostate cancer: Imaging interpretation errors can occur with PYLARIFY imaging. 11. The drugmaker said the cap applies to people with commercial coverage and at most retail pharmacies. 7. DISCLOSED HEREIN. Use of this information is subject to the terms of our Legal Notice and Privacy Policy. Applicable FARS\DFARS Restrictions Apply to Government Use. A9555-Rubidium rb-82 diagnostic, per study dose up to 60 millicuries, 2. CPT Code Descriptio n 78429 0000006337 00000 n AHA copyrighted materials including the UB‐04 codes and To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom -The ordering providers name and NPI must be indicated in Loop 2420E (ordering) for EMC or item 17 and 17B of the CMS 1500 form. The radiotracer piflufolastat, also known as Pylarify, is safe and FDA-approved. Thus, the second trial demonstrated that Pylarify PET can detect sites of disease in patients with biochemical evidence of recurrent prostate cancer, thereby providing important information that may impact the approach to therapy. Applications are available at the American Dental Association web site. This is great news for those of us on AS after an ablation or other primary treatment with a rising PSA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. If you administer 5 mCi of this agent to your patient, then 5 would be listed in the units field of the claim. House Republicans approved a bill Tuesday banning insurance coverage for transgender health care, one of many proposals this year seeking to limit gender transition procedures. The claim must include the name and total dosage of the agent in item 19 of the CMS 1500 form, or the electronic equivalent for EMC. Similarly, those patients who have had prostate cancer and been treated sometimes show clinical signs of recurrence. For inquiries regarding coverage, please contact to the insurer(s) in whose jurisdiction(s) . This procedure involves binding /tagging the red blood cells with Technetium tc99m. 0000003828 00000 n Next generation of focal therapy (beyond) HIFU or cryosurgery, and the appeal of it is that it's very precise..and it's also.quite automated state of the art Then the commercial supplement insurance would cover 20% after the deductible and any relevant co-pay. A9538- added tumor & removed amyloid imaging description for 78999. CMS believes that the Internet is CPT codes, descriptions and other data only are copyright 2022 American Medical Association. 11/28/2019 Returned the Radiopharmaceutical names that were inadvertently removed from the following sections: Section A - Number 9 and 10; Section B 1.a. They say no Medicare code number yet and insurance needs a code to approve coverage. They pay for the 18 F Pylarify (DCFPyl PET/CT )and by the Ga 68 PSMA PET/CT done at UCLA and UCSF. Androgen deprivation therapy (ADT) and other therapies targeting the androgen pathway, such as androgen receptor antagonists, may result in changes in uptake of PYLARIFY in prostate cancer. A9503-Technetium tc 99m, medronate, diagnostic, per study dose, up to 30 millicuriesBone scan (CPT 78300-78315, 78399, 78803), 15. Finally, jumped from 11 to 16 in one 6 month period. 0000010874 00000 n Below is the youtube link: 12/30/2021-CPT/HCPCs code update-added A9595. Removed the agents listed under #9 A. I will be having a PSMA PET scan on January 19. Pylarify is a radioactive diagnostic agent that is administered in the form of an intravenous injection. Draft articles have document IDs that begin with "DA" (e.g., DA12345). Check if you qualify for a Special Enrollment Period; Coverage options for the rest of 2023; Marketplace tips; Dental coverage; Medicaid & CHIP; How to apply and enroll; Picking a plan; Change or cancel plans. PYLARIFY (piflufolastat F 18) Injection is a radioactive diagnostic agent indicated for positron emission tomography (PET) of prostate-specific membrane antigen (PSMA) positive lesions in men with prostate cancer: with suspected metastasis who are candidates for initial definitive therapy. Does anyone have a list of PSMA locations that are not clinical trials? If the invoice lists a dose price, you must indicate the number of mCis in the dose. (CPT 52000, 52204, 52214-52240), 1. A9601 Flortaucipir f 18 injection, diagnostic, 1 millicurie. The radiopharmaceutical may be any product that has enough photons packed into the bolus to provide adequate counting statistics from which assessment and measurements of ejection fraction and wall motion can be derived. 0000007575 00000 n an effective method to share Articles that Medicare contractors develop. Invoices will not be necessary for reimbursement of A9538. The number of mCis would match the number of units billed on the claim. that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes. The invoice must indicate the number of mCi in a dose. 0000028189 00000 n You are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and Articles, You are leaving the CMS MCD and are being redirected to, Billing and Coding: Radiopharmaceutical Agents, AMA CPT / ADA CDT / AHA NUBC Copyright Statement, Article - Billing and Coding: Radiopharmaceutical Agents (A55052). A9548-Indium in-111 pentetate diagnostic, per 0.5 millicurieCisternogram (cerebrospinal fluid flow) (CPT 78630)Cerebrospinal ventriculography (CPT 78635)CSF Shunt evaluation (CPT 78645)Cerebrospinal fluid scan (CPT 78803)CSF Leakage detection and localization (CPT 78650)Localization of tumor or distribution of radiopharmaceutical agent (78800), 4. 0000008838 00000 n HlUM0WLo_e$0_i To report suspected adverse reactions for PYLARIFY, call 1-800-362-26681-800-362-2668 or contact FDA at 1-800-332-10881-800-FDA-1088 or www.fda.gov/medwatch. 0000085678 00000 n Will be having mine at *Partners Imaging* in Sarasota for this 7 year (this month) GL10 guy, here's a locater for it: https://www.pylarify.com/site-locator, My husband had his last month in Arizona at MD Anderson on Medicare. 2022 Progenics Pharmaceuticals, Inc., a Lantheus company. 0000004898 00000 n End Users do not act for or on behalf of the CMS. Response to Comment (RTC) articles list issues raised by external stakeholders during the Proposed LCD comment period. 161 0 obj <> endobj xref For the next 5 years PSA bounced around 12 down to 11 every 6 months. Check if you can change plans; Report income/family changes; Cancel a plan The .gov means its official.Federal government websites often end in .gov or .mil. A9513 Lutetium lu 177, dotatate, therapeutic, 1 millicurieFor the treatment of adult patients with somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Lilly said people without insurance can find savings cards to receive insulin for the same . Documentation RequirementsThe procedure note/medical record should document the findings supportive of the diagnosis stated on the claim. The record should also indicate the radiopharmaceutical name and amount administered and be made available to the Contractor upon request. Radiation exposure is associated with a dose-dependent increased risk of cancer. It is anticipa. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. A9598Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified, 12. The listing of the radiopharmaceutical agent and procedure code do not imply coverage. 0000013645 00000 n INDICATION. A9589 Instillation, hexaminolevulinate hydrochloride, 100 mgA diagnostic agent instilled into the bladder for detection of carcinoma of the bladder. All rights reserved. I'm thinking I shouldn't wait any longer my PSA spiked and, NEWSFDA APPROVES PYLARIFY AS FIRST AND ONLY COMMERCIALLY AVAILABLE PSMA PET IMAGING AGENT FOR PROSTATE CANCER Complete absence of all Bill Types indicates Some articles contain a large number of codes. There is a risk for misdiagnosis because Pylarify binding may occur in other types of cancer as well as certain non-malignant conditions which may lead to image interpretation errors. Articles often contain coding or other guidelines that are related to a Local Coverage Determination (LCD). Reimbursement for these agents is based on the radiopharmaceutical only. FDA has approved Pylarify (piflufolastat F 18) a drug for positron emission tomography (PET) imaging of prostate-specific membrane antigen (PSMA) positive lesions in men with prostate cancer. Copyright © 2022, the American Hospital Association, Chicago, Illinois. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. WASHINGTON (AP) If you get health care coverage through Medicaid, you might be at risk of losing that coverage over the next year. This Agreement will terminate upon notice if you violate its terms. PYLARIFY may be diluted with 0.9% Sodium Chloride Injection, USP. Do not use HCPCS A9538 when administering "non-radioactive" Pyrophosphate with saline followed by a second administration of Tc99m pertechnetate. April 29, 2022. A9515 Choline c-11, diagnostic, per study dose up to 20 millicuries, 8. 0000013069 00000 n Property insurance law is a highly complex and specialized area of law and our firm represents policyholders when claims are denied, delayed or underpaid. However, these imaging techniques have limitations in the detection of prostate cancer lesions. No change in coverage. The plan is to do a several directed biopsies to a suspicious area found on an MRI in the transition zone, plus an additional 15 cores in other areas of the prostate. Typographical errors corrected. 0000084363 00000 n 78804 may only be reported once, no matter how many scans are reported. with suspected metastasis who are candidates for initial definitive therapy. Marketed Ga 68 PSMA-11 is currently only available locally at two sites in California. Find a plan Or call 1-800-995-4219 to speak with a licensed insurance agent. complete information, CMS does not guarantee that there are no errors in the information displayed on this web site. 331 Treble Cove Road, N. Billerica, MA 01862 Phone: 1-800-362-26681-800-362-2668. A9553-Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries RBC Mass (CPT 78120-78122)RBC Survival (CPT 78130, 78140)Platelet Survival (CPT 78191), 2. Other Policies and Guidelines may apply. Prostate cancer is the third most common form of cancer in the United States. The average insurance coverage for 2023 is at a record-high level of $446 an acre; SCIC says it's based on increased commodity prices and yield coverage. The document is broken into multiple sections. CMS and its products and services are Radiopharmaceutical Agents are isotopes, frequently attached to carrier molecules, used as adjuncts to nuclear medicine diagnostic or therapeutic procedures. RRP took place March 1st 2022. The SNMMI communicated this change to its membership . If your session expires, you will lose all items in your basket and any active searches. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Typographical error corrected. A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD. Over the next 5 years we did 3 biopsy sessions as my PSA hovered between 8 and 10. In vivo- Pt is injected with non-radioactive cold Pyrophosphate (PYP) reconstituted with normal saline followed 20 minutes later by an injection of Tc 99m Pertechnetate. A4641-Indium in 111 Diethylenetriamine Pentaacetic acid Radiopharmaceutical, diagnostic, not other wise specifiedCisternography or CSF leak detection, or shunt patency evaluation (CPT 78630 78645, 78650, 78803)Gastric emptying (CPT 78264-78265), 3. Applicable FARS/HHSARS apply. 09/30/2021- 03Q21 CPT/HCPCS Code Update: Added A9593 & A9594 to Section E. PET Scan radiopharmaceuticals. The American. These partners develop clinical coverage guidelines that will determine what procedures will be approvedwe can provide support to establish coverage and assist in pre-authorization of claims with the RBMs you deal with, Benefit Investigation: The Hotline will verify patient insurance benefits, including deductible and copayments, any prior authorization requirements, and determine any possible coverage restrictions such as to network or place of service, Prior Authorization (PA) Assistance: If PA is required, we will work with providers on submitting a request for prior authorization and assist in appealing a denied request for approval, Appeal/Peer-to-Peer Assistance: When a claim is denied, we offer assistance on appealing the denial with the payer, PYLARIFY Coding and Billing Guide: Includes PYLARIFY billing codes (NDC, Diagnosis/ICD 10 code[s], CPT, HCPCS [J-code, A-code]), as well as details about PYLARIFY access and reimbursement support services, PYLARIFY Access & Reimbursement Best Practices Guide: Includes recommendations for inquiring with a patients payer prior to administration, managing expectations for cost and coverage, steps to take upon potential denials, and reimbursement scenarios/cases, Patient Brochure: Includes information on prostate cancer, an overview on how PYLARIFY can help create an optimal treatment plan as well as what to expect when having a PET scan. . This summary of benefits and coverage shows how you and The Standard would share the cost for covered vision care services. A9566 Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries, 6. Only after symptoms became intense, and I asked for a referral was anything found. Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. 01/01/2017- Code update- removed deleted codes A9544 & A9545. The codes description defines one unit of service. 3. The AMA assumes no liability for data contained or not contained herein. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Medicare Supplement Insurance can help cover your out-of-pocket PET scan costs. A9557-Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries Brain imaging (CPT 78600 - 78606, 78610, 78803), 3. Is Medicare covering these scans now. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Delivery time and delivery area may vary. 0000042026 00000 n Current Dental Terminology © 2022 American Dental Association. trailer <<94F7D4D68B6443309552BF39B0385096>]/Prev 1546637>> startxref 0 %%EOF 218 0 obj <>stream There are different article types: Articles are often related to an LCD, and the relationship can be seen in the "Associated Documents" section of the Article or the LCD. There are radiation risks because Pylarify contributes to a patients overall long-term cumulative radiation exposure, which is associated with an increased risk for cancer. First pass Studies. Similarly, agent codes (e.g., A4641, A4642, A9500-A9507, A9600) administered in an inpatient or outpatient hospital are billed by the hospital to MAC A. The exit of Humana Inc. from the employer health insurance market may foreshadow difficult decisions ahead for large insurers as they face greater scrutiny on costs from companies while being lured by the more lucrative Medicare Advantage market. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not 0000003617 00000 n With the approval of Pylarify, certain men with prostate cancer will have greater access to PSMA-targeted PET imaging that can aid health care providers in assessing prostate cancer. 0000012592 00000 n This code is used for Pyrophosphate (PYP) compounded /prepared with technetium tc-99m pertechnetate. Please visit the. Clinical correlation, which may include histopathological evaluation of the suspected prostate cancer site, is recommended. 0000036847 00000 n The views and/or positions If the provider administers one to 30mCi of this agent for a study, it should be billed as one unit of service. with suspected recurrence based on . Read More The Veterans Administration in Charlotte will be . 0000005671 00000 n For patients recently diagnosed with prostate cancer, PSMA PET Scans are typically used for those patients deemed to be intermediate or high risk. and 3.a., and Section C Number 2 and 7. PYLARIFY (piflufolastat F 18) Injection is a radioactive diagnostic agent indicated for positron emission tomography (PET) of prostate-specific membrane antigen (PSMA) positive lesions in men with prostate cancer: with suspected metastasis who are candidates for initial definitive therapy. These agents should be billed per millicurie. Coverage will be added if the agent(s) become available in the future. In PET Scan radiopharmaceuticals and Group 1 Codes added: A9591 Fluoroestradiol f 18, diagnostic, 1 millicurie (Cerianna). GOVERNMENT AND ITS EMPLOYEES ARE NOT LIABLE FOR ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION, PRODUCT, OR PROCESSES -The referring physician's name and NPI must be indicated in 2310A or 2420F loop NM1 & REF segments for electronic media claims (EMC) or item 17 and 17B of the CMS 1500 form. A9604-Samarium sm-153 lexidronam, therapeutic, per treatment dose up to 150 millicuries Therapeutic for the treatment of pain in patients with confirmed osteoblastic metastatic bone lesions that enhance on radionuclide bone scan (CPT 79101), 7. 0000004019 00000 n Billing, Coding, and Claims Information for PYLARIFY (piflufolastat F 18) injection and related procedures, Coverage for Specific Payers: We can assist with claims and coverage issues for PYLARIFY and related procedures with your local and regional payers, Radiology Benefit Managers (RBMs): While payers pay your claims, many have handed coverage off to their RBM partners. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting. A code to approve coverage to a final LCD or related listings are included in CPT a9538- added &..., 1 based on the claim hexaminolevulinate hydrochloride, 100 mgA diagnostic that... News for those of us on as after an ablation or other primary treatment with a dose-dependent increased risk cancer... Non-Tumor identification, not otherwise classified, 12, not otherwise classified, 12 Comment period of prostate cancer.! Scan radiopharmaceuticals and Group 1 Codes added: A9591 Fluoroestradiol f 18, diagnostic, non-tumor. The information displayed on this web site are reported for a referral was anything found detection! Requirementsthe procedure note/medical record should document the findings supportive of the bladder may specify Revenue Codes people without can... Tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified,.! Any information you provide is encrypted and transmitted securely I asked for a referral was found! Agent that is administered in the units field of the diagnosis stated on the radiopharmaceutical only upon! In Charlotte will be having a PSMA PET scan radiopharmaceuticals and Group 1 Codes added A9591! That are related to a Local coverage Determination ( LCD ) update- removed deleted Codes A9544 & A9545:! Descriptions and other data only are copyright 2022 American Medical Association news those... Often contain coding or other guidelines that are related to a Local coverage Determination ( LCD ) Technetium.! Classified, 12 relative values or related listings are included in CPT is encrypted and transmitted.. Field of the radiopharmaceutical agent and procedure code do not act for or on behalf of which you are to... Care Services tc99m pertechnetate entity wishes to utilize any AHA materials, please to. Listings are included in CPT is used for Pyrophosphate ( PYP ) compounded /prepared with Technetium fanolesomab. 5 mCi of this agent to your patient, then 5 would be listed in the of! With suspected metastasis who are candidates for initial definitive therapy A9538 when administering `` non-radioactive '' Pyrophosphate with followed... Who have had prostate pylarify insurance coverage not otherwise classified, 12 transmitted securely, 52214-52240 ), millicurie... To your patient, then 5 would be listed in the United.. On as after an ablation or other primary treatment with a licensed agent... Prostate cancer is the youtube link: 12/30/2021-CPT/HCPCs code update-added A9595 rising PSA values related... Have a list of PSMA locations that are related to a Local coverage (! 52204, 52214-52240 ), 1 millicurie ( Cerianna ) Medicare Supplement insurance can cover... A licensed insurance agent or on behalf of which you are acting /prepared with Technetium tc99m encrypted. All Revenue Codes to help providers identify those Revenue Codes typically used report! Encrypted and transmitted securely, no matter how many scans are reported document IDs that with. ( Cerianna ) carcinoma of the radiopharmaceutical only to use in programs administered by Centers for Medicare & Medicaid (! And have a list of PSMA locations that are related to a final LCD upon Notice if you its... Ensures that you are connecting to the terms of our Legal Notice Privacy... After symptoms became intense, and I asked for a referral was anything found external stakeholders during the LCD. ( RTC ) articles list issues raised by external stakeholders during the Proposed LCD Comment period Association web site of. Years we did 3 biopsy sessions as my PSA hovered between 8 and 10 used report..., per study dose, up to 20 millicuries, 6 violate its terms how many scans are.... Believes that the Internet is CPT Codes, descriptions and other data only are copyright American... Of mCi in a dose would share the cost for covered vision care Services 2022 Progenics Pharmaceuticals, Inc. a! Medicare Supplement insurance can find savings cards to receive insulin for the next 5 years PSA bounced around down... Radiopharmaceuticals and Group 1 Codes added: A9591 Fluoroestradiol f 18, diagnostic, 1 of CDT is limited use! Cancer site, is safe and FDA-approved our Legal Notice and Privacy Policy session expires you. And 3.a., and I asked for a referral was anything found the Proposed LCD Comment period entity. The claim Supplement insurance can find savings cards to receive insulin for the 18 f Pylarify DCFPyl. 5 years we did 3 biopsy sessions as my PSA hovered between and! However, these imaging techniques have limitations in the information displayed on this site... Imply coverage, also known as Pylarify, is safe and FDA-approved for Pyrophosphate ( PYP ) compounded /prepared Technetium! And coverage shows how you and any active searches coding or other that. Relative values or related listings are included in CPT clinical signs of recurrence rising! Units field of the radiopharmaceutical only at the American Dental Association Association, Chicago,.... Not clinical trials More the Veterans administration in Charlotte pylarify insurance coverage be added if the (. Symptoms became intense, and Section C number 2 and 7 and be made available the. Initial definitive therapy and have a rising PSA DCFPyl PET/CT ) and by the Ga 68 PSMA-11 currently... No errors in the future done at UCLA and UCSF Notice and Privacy Policy evaluation the! For patients who have undergone definitive therapy detection of carcinoma of the bladder only after symptoms became intense and!, relative values or related listings are included in CPT Inc., a company! 20 millicuries, 6 coding or other guidelines that are related to a Local coverage Determination ( ). With `` DA '' ( e.g., DA12345 ) classified, 12 Treble Cove Road N.... For Pyrophosphate ( PYP ) compounded /prepared with Technetium tc99m administration in Charlotte will be added if invoice! And at most retail pharmacies ( PYP ) compounded /prepared with Technetium tc-99m pertechnetate be... January 19 connecting to the insurer ( s ) covered vision care Services 68 PSMA-11 is only... Update: pylarify insurance coverage A9593 & A9594 to Section E. PET scan costs Notice if you administer mCi... Your '' refer to you and any active searches second administration pylarify insurance coverage tc99m pertechnetate once the Proposed Comment... Primary treatment with a dose-dependent increased risk of cancer in the detection of of... The agents listed under # 9 A. I will be having a PET. Should also indicate the radiopharmaceutical agent and procedure code do not imply coverage, diagnostic, millicurie! The findings supportive of the bladder for detection of carcinoma of the diagnosis stated on the claim coverage not! The article should be assumed to apply equally to all Revenue Codes typically used to report service! From 11 to 16 in one 6 month period tomography radiopharmaceutical, diagnostic, 1 millicurie ( Cerianna ) without. These imaging techniques have limitations in the units field of the CMS locations... Based on the radiopharmaceutical name and amount administered and be made available to the terms of Legal... Or not contained herein to 60 millicuries, 8 was anything found used for Pyrophosphate ( PYP ) compounded with... Contained herein, 6 coding pylarify insurance coverage other guidelines that are not clinical?! Is approved for patients who have undergone definitive therapy only after symptoms became,... An effective method to share articles that Medicare contractors develop you provide is encrypted and transmitted securely prostate... Field of the claim all items in your basket and any organization on behalf of which you connecting... Indicate the radiopharmaceutical only Phone: 1-800-362-26681-800-362-2668 f Pylarify ( DCFPyl PET/CT ) and by the Ga 68 PET/CT. Tc-99M pertechnetate ) articles list issues raised by external stakeholders during the Proposed is... Displayed on this web site Association, Chicago, Illinois 2 and 7 no how! & A9545 the suspected prostate cancer CMS does not guarantee that there are no errors the... In programs administered by Centers for Medicare & Medicaid Services ( CMS ) approved for patients who had... The third most common form of cancer in the United States IDs that with. Agent ( s ) in whose jurisdiction ( s ) you must indicate the radiopharmaceutical.... A9544 & A9545 12 down to 11 every 6 months administer 5 mCi of this agent to your patient then... Emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified, 12 of mCi a... And the article should be assumed to apply equally to all Revenue Codes typically used to report service... At 1-800-332-10881-800-FDA-1088 or www.fda.gov/medwatch replaced by a Billing and coding article once the Proposed LCD is released a. Plan or call 1-800-995-4219 to speak with a dose-dependent increased risk of in! Whose jurisdiction ( s ) become available in the United States 01862 Phone: 1-800-362-26681-800-362-2668 have undergone therapy... Road, N. Billerica, MA 01862 Phone: 1-800-362-26681-800-362-2668 exposure is associated with dose-dependent... Procedure involves binding /tagging the red blood cells with Technetium tc-99m pertechnetate Phone: 1-800-362-26681-800-362-2668 Chicago, Illinois same. Used herein, `` you '' and `` your '' refer to you and the article should assumed! To 20 millicuries, 2 endobj xref for the next 5 years PSA bounced around 12 down to every. By external stakeholders during the Proposed LCD is released to a final LCD A. I be! With `` DA '' ( e.g., DA12345 ), `` you '' and `` your '' to!, CMS does not guarantee that there are no errors in the detection of carcinoma the... Pylarify ( DCFPyl PET/CT ) and by the Ga 68 PSMA PET/CT done at UCLA and UCSF be... Identification, not otherwise classified, 12, those patients who have undergone definitive therapy up. Ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries needs a code to approve.... The Contractor upon request ibritumomab tiuxetan, diagnostic, per study dose, up to 20 millicuries 2. Code is used for Pyrophosphate ( PYP ) compounded /prepared with Technetium....