A9604, Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Key Coverage Criteria
- Indication: Strontium-89 is medically necessary for symptomatic bone metastases when both: (1) Confirmed osteoblastic bone metastases from solid organ cancer; (2) Pain not adequately controlled by conventional therapy.
1 Active Policy
CARELON-theranostics-therapeutic-radiopharmaceuticals-2026-04-04, Theranostics Therapeutic Radiopharmaceuticals
Related Codes
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