Summary & Overview
CPT 79999: Unlisted Radiopharmaceutical Therapy Procedure
CPT code 79999 is an unlisted CPT procedure code used to report radiopharmaceutical therapy procedures that lack a specific, dedicated code. As a catch‑all for novel or uncommon therapeutic radiopharmaceutical services, 79999 matters nationally because it affects billing clarity, clinical documentation requirements, and payer adjudication for advanced nuclear medicine treatments. Payers commonly involved in coverage and payment decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical context for using 79999, how payers typically approach unlisted radiopharmaceutical therapy claims, and the operational implications for facility and professional billing. The publication covers benchmarks for utilization where available, common administrative and documentation practices tied to unlisted procedure reporting, and policy considerations for claim review and prior authorization. It also outlines typical sites of service for these procedures and the kinds of supporting documentation that payers expect when adjudicating claims submitted with 79999.
The report is national in scope and focuses on billing and policy implications rather than clinical guidance. Data not available in the input will be noted where relevant.
Billing Code Overview
CPT code 79999 is an unlisted procedure code used to report a radiopharmaceutical therapy procedure that does not have a specific CPT code. This code is intended for situations where a clinician performs a therapeutic radiopharmaceutical service that is not described by an existing, more specific CPT code.
Service Type: Radiopharmaceutical therapy procedure
Typical Site of Service: Hospital outpatient setting, hospital inpatient setting, or specialized nuclear medicine/infusion center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient with an uncommon malignancy or a rare indication is referred for radiopharmaceutical therapy that does not have a published, discrete CPT code. Typical patients are adults with metastatic neuroendocrine tumors, refractory thyroid cancer, oligometastatic bone disease, or experimental/compassionate-use indications receiving an institutional radiopharmaceutical that lacks a specific code. The clinical workflow begins with multidisciplinary review (medical oncology, nuclear medicine, and radiation oncology), informed consent, and eligibility confirmation (performance status, organ function, recent imaging). Pre-procedure preparation includes medication review, hydration, and thyroid blockade if applicable. On procedure day the patient is admitted to an outpatient infusion suite or an inpatient nuclear medicine ward depending on radiation safety and observation needs. The radiopharmaceutical is administered intravenously by a nuclear medicine physician or trained advanced practice provider with appropriate radiation-safety oversight. Post-administration monitoring includes vitals, symptom assessment, and radiation surveys. Follow-up includes delayed imaging to assess biodistribution, laboratory monitoring for marrow or organ toxicity, and scheduled clinical visits to assess response and adverse events. Billing uses 79999 to report the therapy when no specific radiopharmaceutical therapy CPT exists; documentation must support the procedure, dosage, indications, and time spent for appropriate valuation and potential use of applicable modifiers.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|