| HCPCS Code: |
A9604 |
| Long Description: |
Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries |
| Short Description: |
Sm 153 lexidronam |
| Pricing Indicator 1: |
57 (Other carrier priced) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| Statute Number: |
|
| Coverage Code: |
C (Carrier judgment) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
|
| Berenson-Eggers Type of Service (BETOS) Code: |
I1E (Standard imaging - nuclear medicine) |
| Type of Service Code 1: |
6 (Therapeutic radiology) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-01-2010 |
| Action Effective Date: |
01-01-2010 |
| Action Code: |
N (No maintenance for this code) |
