Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Excellus BlueCross BlueShieldCommercial · Coverage · Cancer Treatment (Oncology) · NY · Oncology, Nuclear MedicineMedium impact

Radiopharmaceuticals for the Treatment of Cancer 6.01.44

Effective date
Sep 17, 2026
Identified
Jun 20, 2026

Summary

Policy 6.01.44 considers radiopharmaceutical treatments for cancer medically appropriate only within their FDA-approved regimen, and requests in excess of that regimen are considered investigational. Xofigo is considered medically appropriate for castration-resistant prostate cancer with symptomatic bone metastases and no known visceral metastatic disease or bulky regional lymph nodes greater than 3 cm on imaging within the past 30 days. Pluvicto, Lutathera, strontium-89 chloride, and HICON (sodium iodide I 131) are each considered medically appropriate only when their listed criteria are met. The September 18, 2025 review added a new Pluvicto indication and removed Azedra and Zevalin because both are no longer commercially available.

Get alerts when payers change rules like this one

We check Excellus BlueCross BlueShield and other payers every day and email you when a change matches your specialty and state.

Get Excellus BlueCross BlueShield alertsPolicy Monitoring is free. No card required.

What to do

Action · 9 steps
01Current version effective September 17, 2026: Billing team, confirm that each radiopharmaceutical request is within its FDA-approved regimen, because requests beyond that regimen are considered investigational.
02Before billing Xofigo, confirm the record documents castration-resistant prostate cancer, symptomatic bone metastases, and no known visceral metastatic disease or bulky regional lymph nodes greater than 3 cm on imaging within the past 30 days.
03Hematologic evaluation must be performed at baseline and before every Xofigo dose.
04Before the first Xofigo dose, ANC must be 1.5 x 10^9 per L or greater, platelets 100 x 10^9 per L or greater, and hemoglobin 10 g/dL or greater; before later doses, ANC must be 1 x 10^9 per L or greater and platelets 50 x 10^9 per L or greater.
05Before billing Pluvicto, confirm PSMA-positive metastatic castration-resistant prostate cancer, prior treatment with at least one androgen receptor pathway inhibitor (enzalutamide and/or abiraterone), one or two taxane-based regimens or appropriateness to delay taxane-based chemotherapy, and a PSMA PET/CT scan showing at least one PSMA-positive metastatic lesion and no PSMA-negative lesions.
06Before billing Lutathera, confirm the tumor type and Ki-67 limits, positive somatostatin receptor scintigraphy with correlative MRI or CT or a positive 68-Ga-Dotate PET scan, progression after somatostatin analogs, and the absence of the listed contraindications.
07When there is no metastatic disease, document a surgical or medical consult and the reason for inoperability.
08Before billing HICON, confirm remnant ablation criteria, one of the listed adjuvant criteria, or proven unresectable or metastatic disease.
09Before billing strontium-89 chloride, confirm bone pain in patients with confirmed skeletal metastases, and note that repeat doses are generally not recommended at intervals of less than 90 days.

Codes mentioned

77750791017900579403963749637596409A4641A9513A9517A9530A9600A9606A9607C9399C61C79.51C79.52D40.0V58.0Z85.46

Original notice

Radiopharmaceuticals for the Treatment of Cancer 6.01.44
excellusbcbs.com · Always check the source before changing claims.
View original ↗

Related changes

See all Excellus BlueCross BlueShield changes →
Radiopharmaceuticals for the Treatment of Cancer 6.01.44MediumEffective Sep 17, 2026 · Cancer Treatment (Oncology)Magnetic Resonance Imaging (MRI) of the Prostate - (Effective Date - 2026-10-15) 6.01.46HighEffective Oct 15, 2026 · Radiology (x-rays) & ImagingLaboratory Testing for the Screening and Management of Prostate Cancer 2.02.48MediumEffective Sep 17, 2026 · Genetic Disease (Inherited Disease)Germline Genetic Testing for Hereditary Cancers 2.02.60MediumEffective Apr 16, 2026 · Genetic Disease (Inherited Disease)Browse every Excellus BlueCross BlueShield change in the policy list

Related policy hubs

Excellus BlueCross BlueShield policiesNY policy changesOncologyNuclear MedicineCode 77750Code 79101Code 79005Code 79403Code 96374Code 96375Code 96409Code A4641Code A9513Code A9517Code A9530Code A9600Code A9606Code A9607Code C9399Code C61Code C79.51Code C79.52Code D40.0Code V58.0Code Z85.46

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account