Coding and billing best practices
Please consider the following information to help facilitate patient access, successful claims filing, and accurate reimbursement for LUTATHERA® (lutetium Lu 177 dotatate):
- Coding and billing for LUTATHERA varies by site of care
- Hospital outpatient sites of care use the UB-04/CMS-1450 claim form
- Freestanding sites of care use the CMS-1500 (version 02-12) claim form
- Completion of the Freestanding Center (CMS-1500) or Hospital Outpatient (UB-04/CMS-1450) claim form is important for timely and appropriate claims processing and to avoid claim denials
- As a newly approved radiopharmaceutical and until a dedicated product-specific HCPCS code is issued, LUTATHERA will be reported with a miscellaneous HCPCS code, e.g. A9699 or C9031
- Be familiar with Medicare and private payer, coding, and billing requirements and document on claims the payer’s clinical criteria for determining which patients are medically appropriate for LUTATHERA
- Code the patient’s diagnosis and services for appropriate claims processing and reimbursement
- AAA PatientCONNECT™ can provide information on payer coding, billing, and claims submission requirements to help you with claims completion
This website and the information listed within the Coding & Billing section is presented for informational purposes only and is not intended to provide reimbursement or legal advice.
- Laws, regulations, and policies concerning reimbursement are complex and are updated frequently
- While we have made an effort to be current as of the issue date of this document, the information may not be as current or comprehensive when you view it
- Similarly, all Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes are supplied for informational purposes only, and this information does not represent any statement, promise, or guarantee by Advanced Accelerator Applications USA Inc., about coverage, levels of reimbursement, payment, or charge
Consult your payer organization(s) for local coverage and reimbursement policies and determination processes, and your counsel or internal reimbursement specialist for any reimbursement or biling questions specific to your institution.
CPT® codes and descriptions are copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association (AMA).