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Medical Policy Implementation: Radiation Treatment with Lutathera (Lutetium; Lu 177 dotatate)

Effective February 4, 2019, Horizon Blue Cross Blue Shield of New Jersey will change the way we process certain claims based on the guidelines of our new medical policy, Radiation Treatment with Lutathera (Lutetium; Lu 177 dotatate).

We encourage you to review this policy content in our Medical Policy Manual.

Based on the guidelines of this medical policy, claims for services provided February 4, 2019 and after to patients enrolled in Horizon BCBSNJ commercial and Administrative Services Only (ASO) plans¹ will be processed as noted below.

  • HCPCS code C9031 included on professional claims will be denied as a service that should be billed by the facility where the service was performed.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims on and after February 4, 2019.

¹The content of this policy does not apply to services provided to patients enrolled in Horizon BCBSNJ Medicare Advantage plans

Published on: November 5, 2018, 11:30 a.m. ET
Last updated on: November 25, 2020, 01:09 a.m. ET