Summary & Overview
HCPCS Level II A9545: Iodine I-131 Tositumomab, Therapeutic Dose
HCPCS Level II code A9545 designates iodine I-131 tositumomab delivered as a therapeutic radiopharmaceutical, billed per treatment dose. This agent is used in targeted radioimmunotherapy for select hematologic malignancies; its unique billing reflects the drug component rather than the administration procedure. Nationally, accurate coding for radiotherapeutics like A9545 matters for clinical tracking, payer coverage determinations, and facility reimbursement for high-cost, specialty oncology therapies.
Key payers included in this review are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service setting, comparisons of payer coverage posture and reimbursement benchmarks where available, and relevant coding considerations affecting billing workflows. The publication highlights typical sites of care for radiopharmaceutical delivery, common billing challenges for per-dose agents, and implications for hospital outpatient departments and specialty infusion centers.
This summary is intended to inform revenue cycle teams, oncology pharmacy directors, and payers about the billing identity of A9545, coverage alignment across major national payers, and the operational context for delivering iodine I-131 tositumomab.
Billing Code Overview
HCPCS Level II code A9545 represents iodine I-131 tositumomab, therapeutic, per treatment dose. This code describes a radiotherapeutic agent administered as a systemic treatment for certain hematologic malignancies and is billed per treatment dose.
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Service type: Therapeutic radiopharmaceutical administration
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Typical site of service: Hospital outpatient department or specialty infusion center
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with relapsed or refractory non-Hodgkin lymphoma, often CD20-positive follicular lymphoma, who is evaluated for radioimmunotherapy using A9545 (iodine I-131 tositumomab) as a single therapeutic treatment dose. The patient presents after prior lines of chemotherapy and monoclonal antibody therapy with persistent or recurrent measurable disease documented by imaging and hematology-oncology assessment. Pre-treatment workflow includes oncology consultation, review of prior therapies, baseline labs (CBC, renal and hepatic panels, thyroid function), pregnancy test for women of childbearing potential, and discussion of radiation safety. A dosimetry or tracer dose may be administered per institutional protocol to assess biodistribution and suitability, followed by thyroid blockade (e.g., potassium iodide) to protect normal thyroid tissue. On the treatment day, radiopharmacy prepares the therapeutic I-131 tositumomab dose, the patient receives intravenous administration under radiation safety precautions in a designated nuclear medicine or radiation oncology infusion area, and post-infusion monitoring includes vital signs, observation for acute reactions, and discharge instructions regarding radiation precautions. Follow-up includes periodic blood counts to monitor for myelosuppression, repeat imaging to assess response, and long-term surveillance for secondary malignancies or thyroid dysfunction.
Coding Specifications
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