Corporate

May 14, 2014
Updated: September, 9, 2015

Submitting Claims for Xofigo/Radium 223

Xofigo (Radium ra-223) is an alpha particle-emitting radioactive therapeutic agent covered for the FDA approved indications for prostate cancer and bone metastases. 

Correct Reporting of Xofigo:

  • Effective for dates of service 1/1/2015 and after
  • HCPCS code A9606
  • Billed units = per microCurie
  • Additional qualifying information:
    • National Drug Code (NDC) number for Xofigo is not required
    • The exact dosage is based on patient weight in kilograms
  • Current Part B pricing is based on 106% WAC per microCurie
  •  If the agent cannot be used for another patient, please bill for the amount administered and the amount wasted. CGS has suggested that you bill the full amount applicable on one line.
    • Enter the amount administered and the amount wasted to equal the total units billed in Loop 2400 of the electronic claim, or Item 19 for claims submitted on the CMS-1500 claim form.

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