Telix Pharmaceuticals has received transitional pass-through payment status from the U.S. Centers for Medicare and Medicaid Services (CMS) for its Illuccix prostate-specific membrane antigen (PSMA) PET radiopharmaceutical.
Effective July 1, CMS and commercial health insurers will recognize the assigned A9596 Healthcare Common Procedure Coding System (HCPCS) Level II code for reimbursement of Illuccix. The transitional pass-through payment status, which also takes effect on July 1, will enable CMS to provide separate payments for the radiopharmaceutical and the PET/CT scan when performed with Illuccix in the hospital outpatient setting, according to Telix.
Cleared in December 2021, Illuccix is a kit for preparing gallium-68 gozetotide injections for PET imaging in men with suspected prostate cancer metastasis who are candidates for initial definitive therapy or whose cancer may have recurred based on elevated serum prostate-specific antigen levels.
