Question 1

What is HCPCS code A9604?

Accepted Answer

HCPCS code A9604 is "Sm 153 lexidronam". Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries

Question 2

What category is A9604 in?

Accepted Answer

A9604 belongs to HCPCS Category A (Transportation, Medical/Surgical Supplies, Miscellaneous).

Question 3

When should I use HCPCS code A9604?

Accepted Answer

Use A9604 when billing for sm 153 lexidronam. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is A9604 covered by Medicare?

Accepted Answer

Coverage for A9604 (Sm 153 lexidronam) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for A9604?

Accepted Answer

Documentation for A9604 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).