Browse HCPCS Level II 2020 Edition

HCPCS Level II Table of Contents

C2634 - C2699  Brachytherapy Sources

C2634
Brachytherapy source, non-stranded, high activity, iodine-125, greater than 1.01 mci (nist), per source
shortBrachytx, non-str, ha, i-125
MUE
LocationValueAjudication IndicatorRationale
PRA24.03 Date of Service Edit: ClinicalClinical: Data
OPH24.03 Date of Service Edit: ClinicalClinical: Data
C2635
Brachytherapy source, non-stranded, high activity, palladium-103, greater than 2.2 mci (nist), per source
shortBrachytx, non-str, ha, p-103
MUE
LocationValueAjudication IndicatorRationale
PRA124.03 Date of Service Edit: ClinicalClinical: Data
OPH124.03 Date of Service Edit: ClinicalClinical: Data
C2636
Brachytherapy linear source, non-stranded, palladium-103, per 1 mm
shortBrachy linear, non-str,p-103
MUE
LocationValueAjudication IndicatorRationale
PRA690.03 Date of Service Edit: ClinicalClinical: Data
OPH690.03 Date of Service Edit: ClinicalClinical: Data
C2637
Brachytherapy source, non-stranded, ytterbium-169, per source
shortBrachy,non-str,ytterbium-169
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalDrug discontinued
OPH0.03 Date of Service Edit: ClinicalDrug discontinued
C2638
Brachytherapy source, stranded, iodine-125, per source
shortBrachytx, stranded, i-125
MUE
LocationValueAjudication IndicatorRationale
PRA150.03 Date of Service Edit: ClinicalClinical: Data
OPH150.03 Date of Service Edit: ClinicalClinical: Data
C2639
Brachytherapy source, non-stranded, iodine-125, per source
shortBrachytx, non-stranded,i-125
MUE
LocationValueAjudication IndicatorRationale
PRA150.03 Date of Service Edit: ClinicalClinical: Data
OPH150.03 Date of Service Edit: ClinicalClinical: Data
C2640
Brachytherapy source, stranded, palladium-103, per source
shortBrachytx, stranded, p-103
MUE
LocationValueAjudication IndicatorRationale
PRA150.03 Date of Service Edit: ClinicalClinical: Data
OPH150.03 Date of Service Edit: ClinicalClinical: Data
C2641
Brachytherapy source, non-stranded, palladium-103, per source
shortBrachytx, non-stranded,p-103
MUE
LocationValueAjudication IndicatorRationale
PRA150.03 Date of Service Edit: ClinicalClinical: Data
OPH150.03 Date of Service Edit: ClinicalClinical: Data
C2642
Brachytherapy source, stranded, cesium-131, per source
shortBrachytx, stranded, c-131
MUE
LocationValueAjudication IndicatorRationale
PRA120.03 Date of Service Edit: ClinicalClinical: Data
OPH120.03 Date of Service Edit: ClinicalClinical: Data
C2643
Brachytherapy source, non-stranded, cesium-131, per source
shortBrachytx, non-stranded,c-131
MUE
LocationValueAjudication IndicatorRationale
PRA120.03 Date of Service Edit: ClinicalClinical: Data
OPH120.03 Date of Service Edit: ClinicalClinical: Data
C2644
Brachytherapy source, cesium-131 chloride solution, per millicurie
shortBrachytx cesium-131 chloride
MUE
LocationValueAjudication IndicatorRationale
PRA500.01 Line EditPrescribing Information
OPH0.03 Date of Service Edit: ClinicalCMS Policy
C2645
Brachytherapy planar source, palladium-103, per square millimeter
shortBrachytx planar, p-103
MUE
LocationValueAjudication IndicatorRationale
PRA4608.03 Date of Service Edit: ClinicalPrescribing Information
OPH4608.03 Date of Service Edit: ClinicalPrescribing Information
C2698
Brachytherapy source, stranded, not otherwise specified, per source
shortBrachytx, stranded, nos
C2699
Brachytherapy source, non-stranded, not otherwise specified, per source
shortBrachytx, non-stranded, nos