Table of content for "Lutetium lu 177 dotatate, tx" (HCPCS C9031)
General information on the “C9031” code
HCPCS Code: C9031
Long Description: Lutetium lu 177, dotatate, therapeutic, 1 mci
Short Description: Lutetium lu 177 dotatate, tx
Original information is taken from C9031 page
Pricing indicators
Pricing Indicator Code 1: 53 – Statute
Multiple Pricing Indicator Code A : Not applicable as HCPCS priced under one methodology
Certification and additional reference information
Statute Number: 1833(t)
Cross Reference Code 1: A9513 ;
Coverage
Coverage: D – Special coverage instructions apply
Type of service
Berenson-Eggers Type of Service (BETOS): O1D – Chemotherapy
Type Of Service 1: 9 – Other medical items or services
Type Of Service 2: F – Ambulatory surgical center (facility usage for surgical services)
Misc information
Anesthesia Base Unit Quantity: 0
Code Added Date: 20180701
Code Effective Date: 20190101
Termination Date: 20181231
Action Code: N – No maintenance for this code