HCPCS Code A9513: Lutetium Lu-177, Dototate, Therapeutic, 1 Millicurie

HCPCS code A9513 represents Lutetium Lu 177, dotatate, a therapeutic radiopharmaceutical used in 1 millicurie units for treating somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and hindgut neuroendocrine tumors. It binds to somatostatin receptors and delivers targeted radiation, offering treatment options for locally advanced or unresectable cases.

Medicare covers HCPCS code A9513 (Lutetium Lu 177 dotatate) under indications listed in FDA-approved labeling. Coverage requires prior authorization and is limited to cases of medical necessity for the treatment of somatostatin receptor-positive neuroendocrine tumors. Medicare coverage criteria include patient age, confirmed diagnosis, and use as specified in FDA-approved labeling. Prior authorization and coverage criteria can vary by MAC and local Medicare policies.

Lutathera (Lutetium Lu 177 dotatate) is approved for neuroendocrine tumors that are somatostatin receptor-positive, while Pluvicto (Lutetium Lu 177 vipivotide tetraxetan) is indicated for PSMA-positive metastatic castration-resistant prostate cancer. Both are radiopharmaceuticals produced by Advanced Accelerator Applications, offering other indications and different clinical pathways.

HCPCS A9513 billing requires reporting units by millicurie administered, using JZ/JW modifiers for full or partial doses. Proper documentation supports claims and reimbursement by Medicare and payers.