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HCPCS Code C2645

Official Description

Brachytherapy planar source, palladium-103, per square millimeter

Short Descr	Brachytx planar, p-103
Coverage	Special coverage instructions apply
Pricing Indicator(s)	53 – Statute
MPI	A – Not applicable, as HCPCS priced under one methodology
Statute	1833(T)
ASC Payment Group Code	YY – 1/01/2016
BETOS	I4B – Imaging/procedure - other
TOS Code(s)	9 – Other medical items or services
Added Date	1/1/2016
APC Status Indicator	Brachytherapy Sources
ASC Payment Indicator	Brachytherapy source paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate.
MUE	4608
MUE	Not applicable/unspecified.
OTS Orthotic	No

C1052-C9898 Temporary Hospital Outpatient PPS

C1715-C2699 Brachytherapy Services/Supplies

C1715 Brachytherapy needle

C1716 Brachytx, non-str, gold-198

C1717 Brachytx, non-str,hdr ir-192

C1719 Brachytx, ns, non-hdrir-192

C2616 Brachytx, non-str,yttrium-90

C2634 Brachytx, non-str, ha, i-125

C2635 Brachytx, non-str, ha, p-103

C2636 Brachy linear, non-str,p-103

C2637 Brachy,non-str,ytterbium-169

C2638 Brachytx, stranded, i-125

C2639 Brachytx, non-stranded,i-125

C2640 Brachytx, stranded, p-103

C2641 Brachytx, non-stranded,p-103

C2642 Brachytx, stranded, c-131

C2643 Brachytx, non-stranded,c-131

C2644 Brachytx cesium-131 chloride

C2645 Brachytx planar, p-103

C2698 Brachytx, stranded, nos

C2699 Brachytx, non-stranded, nos

Date	Action	Notes
2016-01-01	Added	Added

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