Summary & Overview
HCPCS A9607: Lutetium Lu 177 Vipivotide Tetraxetan, Therapeutic, 1 mCi
HCPCS Level II code A9607 identifies a therapeutic radiopharmaceutical: lutetium lu 177 vipivotide tetraxetan, billed per 1 millicurie. This code is used when administering targeted lutetium-177 radioligand therapy, an emerging modality in oncology for certain malignancies. Nationally, the code matters because radiopharmaceutical therapies involve specialized handling, administration, and reimbursement pathways that affect provider operations, payer coverage decisions, and patient access.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of clinical context for radioligand therapy, typical sites of care, and what to expect in billing practice for A9607.
The publication summarizes benchmark considerations, common billing and coverage themes, and recent policy trends relevant to radiopharmaceuticals. It provides operational context for coding and claims submission, highlights typical payer coverage approaches, and outlines areas where facilities and clinicians should expect administrative complexity. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code A9607 represents lutetium lu 177 vipivotide tetraxetan, therapeutic, 1 millicurie. This code denotes a radiotherapeutic pharmaceutical dose of lutetium-177 labeled vipivotide tetraxetan used for targeted radioligand therapy.
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Service type: Radiopharmaceutical therapeutic injection/infusion
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Typical site of service: Hospital outpatient department or specialized outpatient infusion/radiation therapy center
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with metastatic castration-resistant prostate cancer (mCRPC) and rising prostate-specific antigen presents for lutetium-177 vipivotide tetraxetan therapy. The patient completed baseline pretherapy evaluation including recent PSMA PET/CT confirming PSMA-avid metastatic lesions and labs showing adequate bone marrow, renal, and hepatic function. On day of service, the patient is brought to an outpatient nuclear medicine or radiation oncology infusion suite or an authorized radiopharmacy/therapeutic nuclear medicine center. The multidisciplinary workflow includes verification of indication and informed consent, dose calculation in millicuries, radiation safety briefing, administration of A9607 (Lutetium lu 177 vipivotide tetraxetan) by authorized nuclear medicine or radiation oncology staff via slow intravenous infusion, post-infusion monitoring for acute reactions, and discharge with radiation safety instructions and outpatient follow-up for response assessment and toxicity monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
07 | Service furnished following discharge from acute care inpatient hospitalization | Use when therapy is administered within the global period after inpatient discharge per payer rules. |