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Reimbursement


Under the terms of the Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003, Medicare, for the most part, reimburses hospitals for the cost of outpatient treatment with SIR-Spheres® Y-90 resin microspheres.

Many private payers also acknowledge the clinical utility of the SIRT procedure and have issued positive coverage policies for treatment. These payers include Aetna, Anthem, Cigna, Healthnet, Humana, United Healthcare, Wellpoint, and many independent Blue Cross/Blue Shield plans, as well as many other smaller plans on a case-by-case basis.

Please see the 2019 Coding Guide for more information.



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