This coverage article has been revised and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (HI and Territories), and 01312 (NV).

Effective Date: April 01, 2021

Summary of Article Changes: The following information was added in CPT/HCPCS Codes and the ICD-10 Codes that Support Medical Necessity sections respectively.

• Group 1 HCPCS Codes added and deleted:
  • Added A9592- Copper Cu64 Dotatate, 1 millicurie, and
  • Deleted C9068 - Copper Cu64 Dotatate diagnostic, 1 millicurie in the OPPS setting.
• In the Group 13 Paragraph:
  • Corrected the CR number from CR 9861 to CR 11907.
• In the Group 14 Paragraph:
  • Corrected CR 9861 to CR 12029, and
  • Replaced HCPCS codes A9897 - Positron Emission Tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified with A9592 - Copper Cu64 Dotatate, 1 millicurie and deleted C9068 - Copper Cu64 Dotatate, 1 millicurie.

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