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Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Oncology, Nuclear MedicineMedium impact

Therapeutic Radiopharmaceuticals for Prostate Cancer

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Lutetium Lu 177 vipivotide tetraxetan (Lu-177-PSMA-617) may be considered medically necessary for adults with PSMA-positive metastatic castration-resistant prostate cancer who have 1 or more PSMA-positive lesions, or metastatic disease that is predominately PSMA-positive with no dominant PSMA-negative metastatic lesions, and who have been treated previously with androgen receptor-directed therapy and taxane-based chemotherapy. It is considered investigational for prostate cancer when these criteria are not met. In March 2025, the FDA indication for Lu-177-PSMA-617 was updated to also include individuals with PSMA-positive mCRPC who have been treated with AR pathway inhibition and are considered appropriate to delay taxane-based chemotherapy.

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What to do

Action · 6 steps
01Billing team: Before billing HCPCS A9607 (Lutetium Lu 177 vipivotide tetraxetan, therapeutic, 1 mCi), confirm the patient is an adult with PSMA-positive metastatic castration-resistant prostate cancer who meets the criteria above, including previous treatment with androgen receptor-directed therapy and a taxane-based chemotherapy.
02Do not bill this therapy as medically necessary for patients who do not meet these criteria, since the policy considers it investigational for prostate cancer in that case.
03Patients should be selected for treatment using gallium Ga 68 gozetotide or an approved PSMA-11 imaging agent based on PSMA expression in tumors.
04Providers should use the drug only under the control of physicians qualified by specific training and experience in the safe use and handling of radiopharmaceuticals.
05For Federal Employee Program members, FDA-approved drugs may be assessed only on the basis of medical necessity.
06BCBSMS makes no payment for services not documented to be medically necessary.

Codes mentioned

A9607C61C79.82D07.5

Original notice

Therapeutic Radiopharmaceuticals for Prostate Cancer
bcbsms.com · Always check the source before changing claims.
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Related changes

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Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesOncologyNuclear MedicineCode A9607Code C61Code C79.82Code D07.5

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