Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Nuclear Medicine, Urology, OncologyMedium impact
Radioimmunoscintigraphy (Monoclonal Antibody Imaging) With Indium 111 Capromab Pendetide for Prostate Cancer
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
This policy was last reviewed 06/24/2024 with no changes. Radioimmunoscintigraphy using indium 111 capromab pendetide (ProstaScint) is considered investigational for the evaluation and management of individuals with prostate cancer. The FDA approved this agent in 1996 through the biologics license application process as a diagnostic imaging agent for newly diagnosed, biopsy-proven, clinically localized, high-risk prostate cancer and for post-prostatectomy patients with a rising PSA and a negative or equivocal standard metastatic evaluation. Investigational codes listed are CPT 78800 through 78804 and HCPCS A9507.
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01Billing team: Radioimmunoscintigraphy with indium 111 capromab pendetide for prostate cancer is investigational, and BCBSMS makes no payment for services not documented to be Medically Necessary.
02Claims for HCPCS A9507 (indium In-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries) and for the CPT codes 78800 through 78804 listed as investigational are under this investigational statement.
03Federal Employee Program (FEP) members may have FDA-approved devices, drugs or biologics assessed only on the basis of medical necessity.
Codes mentioned
7880078801788027880378804A9507
Original notice
Radioimmunoscintigraphy (Monoclonal Antibody Imaging) With Indium 111 Capromab Pendetide for Prostate Cancer
bcbsms.com · Always check the source before changing claims.
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