HCPCS Level II › C codes C2641 Brachytx, non-stranded,p-103Brachytherapy source, non-stranded, palladium-103, 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 C2641 Payer coverage policies that name C2641 C2641 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: $61.26 (asc), effective Oct 1, 2026 IN: $0.00 (professional, Advanced Practice Nurse (85%), non-facility), effective Sep 21, 2018 KY: $64.48 (asc), effective Jan 1, 2026 MS: $47.93 (comprehensive), effective Jul 1, 2026 ND: $0.00 (physician), effective Aug 1, 2026 OK: $57.42 (asc), effective Jan 1, 2026 VT: $49.00 (outpatient_hospital_opps), effective Feb 1, 2026 WY: $27.91 (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.