HCPCS Level II › C codes C2645 Brachytx planar, p-103Brachytherapy planar source, palladium-103, per square millimeter
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 4608 units per day (clinical), rationale: Prescribing Information Outpatient hospital: max 4608 units per day (clinical), rationale: Prescribing Information Payer policies and prior authorization for C2645 Payer coverage policies that name C2645 C2645 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Brachytherapy (0371) covered if criteria are met May 20, 2026 payer document
Medicaid fee-for-service AZ: $4.46 (asc), effective Oct 1, 2017 IN: $0.00 (professional, Advanced Practice Nurse (85%), non-facility), effective Sep 21, 2018 KY: $4.69 (asc), effective Jan 1, 2026 MS: $3.49 (comprehensive), effective Jul 1, 2026 ND: $0.00 (physician), effective Aug 1, 2026 VT: $3.56 (outpatient_hospital_opps), effective Feb 1, 2026 WY: $2.03 (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.