Summary & Overview
HCPCS C2638: Brachytherapy Source, Stranded Iodine-125, Per Source
HCPCS Level II code C2638 designates a stranded iodine-125 brachytherapy source billed per source. Brachytherapy sources such as stranded iodine-125 seeds are integral to localized radiation treatment for certain cancers, enabling targeted dose delivery while sparing surrounding tissue. National attention to this code centers on supply costs, appropriate use in oncology workflows, and accurate service-line billing.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of what this code represents clinically, typical sites of service, and the payer landscape in which reimbursement policy and coverage determinations commonly arise.
This publication provides benchmarks and coverage context, highlights relevant policy updates affecting supply and implant billing, and summarizes clinical considerations tied to the use of stranded iodine-125 seeds in brachytherapy. The content is intended for billing professionals, radiation oncology administrators, and policy analysts seeking a clear national-level briefing on coding and payer interactions for C2638.
Billing Code Overview
HCPCS Level II code C2638 represents a brachytherapy source, stranded, iodine-125, billed per source. This supply is used in radiation oncology procedures that implant radioactive seeds for localized treatment of malignancies.
Service type: Brachytherapy radioactive source supply
Typical site of service: Hospital outpatient department or ambulatory surgical center where brachytherapy implantation procedures are performed
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Clinical & Coding Specifications
Clinical Context
A 68-year-old male with localized prostate cancer is scheduled for low-dose-rate (LDR) brachytherapy using stranded iodine-125 sources. The patient has confirmed intermediate-risk disease by prostate-specific antigen, Gleason score, and clinical stage. Pre-procedure planning includes multiparametric prostate MRI and transrectal ultrasound (TRUS)-based treatment planning to define target volumes and calculate seed activity and spacing. On the day of the procedure, the patient undergoes spinal or general anesthesia in an operating room or ambulatory surgical center. A transperineal template-guided approach is used to implant C2638 stranded iodine-125 sources into the prostate under TRUS guidance. Post-implant dosimetry is performed with CT or MRI within 24 to 30 days to verify dose distribution. Typical clinical workflow steps include consultation and consent, preplanning imaging, treatment planning and seed ordering, anesthesia and implant procedure, postimplant imaging/dosimetry, and follow-up oncology visits for toxicity monitoring and PSA surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unmodified procedure | When no modifier applies and the service is the standard service as reported. |