Billing and Coding: Xofigo Billing Instructions

Coverage is for radium Ra-223 (Xofigo) to treat castration-resistant prostate cancer with symptomatic bone metastases when no visceral metastatic disease is present. Claims must use HCPCS A9606, include ICD-10 C61 plus C79.51 or C79.52, and include a narrative attesting that visceral metastases are absent; the recommended regimen is 55 kBq/kg IV every 4 weeks for up to 6 doses.

"Treatment of patients with castration-resistant prostate cancer with symptomatic bone metastases and no known visceral metastatic disease."

Sign up to see full coverage criteria, indications, and limitations.