Summary & Overview
HCPCS Level II C9031: Lutetium Lu 177 Dotatate Therapeutic, 1 mCi
HCPCS Level II code C9031 represents a therapeutic dose of lutetium Lu 177 dotatate (1 mCi), a radiopharmaceutical used in peptide receptor radionuclide therapy (PRRT) for neuroendocrine tumors. As radiopharmaceutical oncology treatments expand, accurate coding for agents such as C9031 is important for claims processing, coverage determinations, and consistent payment across settings. Nationally, this code matters because it addresses a high-cost, specialized therapy administered in controlled clinical environments.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context on the therapeutic use and typical sites of service for C9031, plus practical benchmarks and policy-oriented information where available. The publication summarizes reimbursement benchmarks, payer coverage patterns, and billing considerations relevant to radiopharmaceutical administration, and it highlights recent policy updates affecting coding and payment for lutetium-based therapies.
The content provides an executive overview suitable for billing managers, oncology program directors, and revenue cycle professionals seeking a concise reference to HCPCS Level II code C9031 and its role in modern radiopharmaceutical oncology care.
Billing Code Overview
HCPCS Level II code C9031 describes Lutetium Lu 177 dotatate, therapeutic, 1 mCi. This entry represents a radiopharmaceutical therapeutic dose of lutetium Lu 177 dotatate, used in peptide receptor radionuclide therapy (PRRT) for neuroendocrine tumors and related indications.
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Service type: Radiopharmaceutical therapeutic administration
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Typical site of service: Hospital outpatient department or specialized infusion/radiation oncology center
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a metastatic or inoperable somatostatin receptor–positive neuroendocrine tumor (NET) who has progressed on or is unsuitable for somatostatin analog therapy. The patient undergoes treatment with C9031 (lutetium Lu 177 dotatate, therapeutic, 1 mCi) administered in a specialized nuclear medicine or radiation oncology infusion suite. Workflow: initial multidisciplinary evaluation (medical oncology, nuclear medicine, and radiation safety), confirmation of somatostatin receptor positivity via Ga-68 DOTATATE PET/CT, baseline labs (CBC, renal and hepatic function), informed consent and treatment planning, antiemetic and amino acid infusion for renal protection, administration of C9031 by authorized nuclear medicine personnel with radiation safety precautions, post-therapy monitoring for acute reactions and delayed hematologic or renal toxicity, scheduled follow-up visits with laboratory surveillance and imaging to assess response and toxicity management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when treatment is specifically applied to a left-sided anatomic target and payer requires laterality reporting (rare for systemic radiopharmaceuticals). |