Dear There,
SIR-Spheres® Y-90 resin microspheres is a medical device used in Selective Internal Radiation Therapy (SIRT).
- Selective internal radiation therapy (SIRT) with SIR-Spheres® Y-90 resin microspheres is a prescription device for the treatment of inoperable liver tumors.
- SIRT is administered to patients by interventional radiologists, who infuse millions of radioactive resin microspheres (diameter between 20–60 microns) via a catheter into the liver arteries that supply blood to the tumors.
- The microspheres are extremely small resin beads, approximately thirty-two microns in diameter, about a third of the width of a human hair.
- Y-90 resin microspheres contain the radioactive element yttrium-90, which delivers radiation over a short distance in human tissue.
- By leveraging the fact that the hepatic artery supplies blood to liver tumors, the provider can target microspheres directly to the tumors, delivering a dose of radiation that is up to 40 times higher than conventional radiotherapy, while sparing healthy tissue.
Indication:
SIR-Spheres yttrium-90 resin microspheres: Colorectal cancer metastasized to the liver in combination with hepatic arterial chemotherapy (FUDR)-Full PMA approval.
Goal
The goal is to inform payer professionals how Interventional Radiologists utilize our Y-90 brachytherapy device to help treat people with liver cancer. The purpose of this piece is to provide information and guidance on reimbursement and coding to simplify claim processing and reduce common errors in coverage.
SIR-Spheres are a brachytherapy device that can billed separately under the Medicare Modernization Act of 2003.
There is 2-Step treatment process for using SIR-Spheres
- Mapping Day-pre-planning of treatment using arterial embolization
- Treatment Day-utilization Y-90 via tumor embolization
SIR-Spheres has three different product billing codes. Choosing the correct billing code allows for more efficient claim adjudication. Using the incorrect HCPCS code can cause a denial of payment and a need for resubmission of the claim. Reimbursement for device codes will vary be payer type, payer contracts and place of service. It is important that treatment sites conduct a predetermination to verify coverage.
