Summary & Overview
HCPCS A9513: Lutetium Lu 177 Dotatate, Therapeutic, 1 Millicurie
HCPCS Level II code A9513 designates Lutetium Lu 177 dotatate supplied for therapeutic use and billed per 1 millicurie. This radiopharmaceutical is used in targeted peptide receptor radionuclide therapy for select neuroendocrine tumors and represents an important component of advanced oncologic outpatient treatment. Nationally, the code matters because it captures the supply unit for a high-cost, specialty radiopharmaceutical that has implications for facility billing, drug acquisition costs, and payer coverage policies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, expected site-of-service patterns, and what to expect in payer engagement for this item. The publication provides benchmarks and policy-relevant context where available, including common billing practices for radiopharmaceutical units, coding considerations tied to single-unit reporting, and how payers typically categorize such therapies for coverage and payment. Data not available in the input will be noted as such; the content focuses on national-level implications, clinical rationale for the supply, and practical billing context for hospital outpatient and infusion settings.
Billing Code Overview
HCPCS Level II code A9513 represents Lutetium Lu 177 dotatate supplied for therapeutic use, billed per 1 millicurie. This item is a radiopharmaceutical used in targeted radionuclide therapy for certain neuroendocrine tumors.
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Service type: Therapeutic radiopharmaceutical administration
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Typical site of service: Hospital outpatient department or outpatient infusion center, where radiopharmaceutical therapies are administered under controlled conditions
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with metastatic, well-differentiated, somatostatin receptor–positive neuroendocrine tumor (NET) who is referred for peptide receptor radionuclide therapy (PRRT) using lutetium Lu 177 dotatate. The multidisciplinary workflow includes confirmation of somatostatin receptor positivity by Gallium-68 DOTATATE PET/CT, review by medical oncology and nuclear medicine, baseline labs (CBC, renal and hepatic function), and informed consent addressing radiation precautions. On treatment day the patient presents to an outpatient nuclear medicine infusion suite or hospital outpatient department. A radiopharmacy prepares the radiopharmaceutical measured in millicuries per A9513 unit. The patient is placed on an infusion pump or slow intravenous injection under radiation safety protocols; antiemetics and amino acid infusion for renal protection may be administered concurrently. Post-infusion, the patient is observed for acute reactions, vitals monitored, and discharge instructions include radiation safety, follow-up imaging, and scheduled subsequent PRRT cycles. Typical site of service is an outpatient hospital or specialized cancer center nuclear medicine/infusion suite. The service type is therapeutic radiopharmaceutical administration of lutetium Lu 177 dotatate billed per millicurie via HCPCS Level II code A9513.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
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