HCPCS Level II › C codes C2639 Brachytx, non-stranded,i-125Brachytherapy source, non-stranded, iodine-125, per source
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 150 units per day (clinical), rationale: Clinical: Data Outpatient hospital: max 150 units per day (clinical), rationale: Clinical: Data Payer policies and prior authorization for C2639 Payer coverage policies that name C2639 C2639 appears in 2 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi.
Payer Policy Role in policy Reviewed Document Aetna Brachytherapy (0371) covered if criteria are met May 20, 2026 payer document Blue Cross & Blue Shield of Mississippi Brachytherapy For Clinically Localized Prostate Cancer Using Permanently Implanted Seeds (L.8.01.417) covered if criteria are met payer document
Medicaid fee-for-service AZ: $34.81 (asc), effective Oct 1, 2026 IN: $0.00 (professional, Advanced Practice Nurse (85%), non-facility), effective Sep 21, 2018 KY: $36.64 (asc), effective Jan 1, 2026 MS: $27.23 (comprehensive), effective Jul 1, 2026 ND: $0.00 (physician), effective Aug 1, 2026 OK: $32.63 (asc), effective Jan 1, 2026 VT: $27.85 (outpatient_hospital_opps), effective Feb 1, 2026 WY: $15.86 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.