Table of content for "Sm 153 lexidronam" (HCPCS A9604)
General information on the “A9604” code
HCPCS Code: A9604
Long Description: Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries
Short Description: Sm 153 lexidronam
Original information is taken from A9604 page
Pricing indicators
Pricing Indicator Code 1: 57 – Other carrier priced
Multiple Pricing Indicator Code A : Not applicable as HCPCS priced under one methodology
Certification and additional reference information
Coverage
Coverage: C – Carrier judgment
Type of service
Berenson-Eggers Type of Service (BETOS): I1E – Standard imaging - nuclear medicine
Type Of Service 1: 6 – Therapeutic radiology
Misc information
Anesthesia Base Unit Quantity: 0
Code Added Date: 20100101
Code Effective Date: 20100101
Action Code: N – No maintenance for this code