Does A9699 require prior authorization?

Yes, A9699 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for A9699?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`A9699`, Radiopharmaceutical, therapeutic, not otherwise classified

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Every Part A claim for NOC/unlisted drug, biologic, and radiopharmaceutical codes must include the appropriate NOC code and the appropriate diagnosis.
Every claim must include the appropriate revenue codes for the drug and for IV infusion when applicable.

Key Coverage Criteria

For claims using not otherwise classified (NOC)/unlisted HCPCS codes J3490, J3590, J9999, A4641, or A9699 with limited or specific indications, submit required documentation in the claim remarks field (Field Locator 80 on the UB-04) or the equivalent 5010 electronic claim field so Palmetto GBA can ascertain FDA labeling indications have been met.
For oncology drugs or oncology radiopharmaceuticals submitted with NOC codes prior to assignment of a unique HCPCS code, include the diagnosis code that corresponds to the specific FDA label indication or, if no adequate diagnosis code exists, include a specific narrative description of the indication (e.g., 'squamous cell carcinoma').
Coverage of injectable oncology medications is based on NCCN Compendium Categories of Evidence and Consensus (1, 2A, 2B = proven/medically necessary; 3 = unproven/not medically necessary); if NCCN is unavailable, base decisions on FDA labeling.
Coverage is provided for injectable oncology medications listed in the NCCN Compendium with Categories of Evidence and Consensus of 1, 2A, or 2B as proven and medically necessary; categories with 3 are unproven and not medically necessary.
Coverage is provided for injectable oncology medications listed in the NCCN Compendium with Categories of Evidence and Consensus of 1, 2A, or 2B as proven and medically necessary; Category 3 is unproven and not medically necessary. If NCCN has no compendium, coverage determinations are based on FDA labeling.
Indication: Strontium-89 is medically necessary for symptomatic bone metastases when both: (1) Confirmed osteoblastic bone metastases from solid organ cancer; (2) Pain not adequately controlled by conventional therapy.

11 Active Policies

EVICORE-HPLAN-CIGNA-AFCE721BA4F3, Cigna Comprehensive Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA-08C913805997, Cigna Commercial Radiation Oncology Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA_MEDICARE-A88AF85430B7, Cigna OBM Radiation Oncology Code List - Effective 01/01/2026

EVICORE-HPLAN-CIGNA_MEDICARE-0348DA3099BA, Cigna Commercial & Medicare Advantage Radiation Oncology Code List - Effective 01/01/2026

EVICORE-HPLAN-EMBLEM_GHI-8F6385AD7D76, GHI/Emblem Non-City of New York & Medicare Radiation Oncology Code List - Effective 01/01/2026

EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-0414D494E567, Health Partners Plans Radiation Therapy Code List - Effective 01/01/2025

A54880, Billing and Coding: Additional Claim Documentation Requirements for Not Otherwise Classified (NOC) Drugs and Biological Products with Specific FDA Label Indications

UMR-POL-UMR-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage

SUREST-POL-SUREST-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage

CARELON-theranostics-therapeutic-radiopharmaceuticals-2026-04-04, Theranostics Therapeutic Radiopharmaceuticals

UHC-POL-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage

`A9699`, Radiopharmaceutical, therapeutic, not otherwise classified

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

Have a follow-up question?

A9699, Radiopharmaceutical, therapeutic, not otherwise classified

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

Have a follow-up question?

`A9699`, Radiopharmaceutical, therapeutic, not otherwise classified