It is important to note this code is billable once per course of therapy, as the clinical treatment plan is a professional-only service. It is not appropriate to report an additional clinical treatment plan for the boost portion of a course of treatment.
Full Answer
CPT® 77331 is billable once per port/field/angle, per course of 2D or 3D external beam radiation therapy only when medically necessary and ordered by a radiation oncologist.
One (1) 3D radiotherapy plan (CPT® 77295) may be approved for each course of Stereotactic Radiosurgery (SRS) or Stereotactic Body Radiation Therapy (SBRT). (See Reference 1.) 3D radiotherapy plans may be appropriate for HDR and LDR brachytherapy treatment courses.
CPT® 77321 is not billable for simply utilizing electrons. An isodose plan must be created except for total-body or hemi-body electron treatments. One (1) teletherapy port plan (CPT® 77321) may be approved for all computer-based planning of electron treatments and all proton and neutron isodose planning.
Radiation treatment delivery: G codes G6003-G6014 will be used in the MPFS and CPT codes 77402, 77407, and 77412 will be used in OPPS. IMRT: G codes G6015 and G6016 are used for payment under the MPFS and CPT codes 77385 and 77386 will be used in OPPS.
Basic dosimetry calculations (CPT code 77300) may be reported as many times as the calculations are performed. The typical course of radiation therapy will require from one to six dosimetry calculations, depending on the complexity of the patient's problem.
Only 1 verification simulation is allowed per phase of treatment. For HDR brachytherapy treatments, one (1) verification simulation (CPT® 77280) may be approved per treatment. Additional services may be requested and will be reviewed for medical necessity based on individual patient circumstances.
CPT code 77334 is typically billed multiple times (often on the same day of service), once for each of the separate IMRT fields as required by the plan during the course of IMRT treatment. The typical case will require up to ten (10) devices.
77263 is only billable once per course of treatment.
Standards for CPT® 77338 CPT® 77338 may only be billed one (1) time per IMRT plan created. other type of isodose planning. In the event of an IMRT boost, the treatment device is allowed even though the additional plan may not be allowed.
CPT® codes 77370 and 77470 are used to report the additional time and effort required when a medical physicist and radiation oncologist must plan for and deliver treatment under unusual clinical circumstances. Neither code should be billed routinely in connection with usual and customary services.
weekly77336 Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the prescription, reported once per each 5 fractions of therapy. This is commonly referred to as “weekly physics”.
This code is billed once per patient course of treatment. It would not be appropriate to bill an IMRT plan (CPT® 77301), a 3D radiotherapy plan (CPT® 77295) or an isodose plan (CPT® 77306 – 77307) and a special teletherapy port plan (CPT® 77321) on the same date of service for the same volume of interest.
CPT code 77432 can only be reported one time per session of single fraction cranial SRS. If cranial SRS is delivered in two to five fractions, CPT code 77435 should be reported once for the entire course of treatment.
Clinical treatment planning codes (CPT codes 77261-77263) are the professional charges for the physician to integrate the patient's overall medical condition and extent of disease and to formulate a plan of therapy for the patient.
Phone calls during treatment are included in the work captured in CPT code 77427, which includes a 90-day global period after treatment is completed, and therefore CPT codes 99441 – 99443 cannot be billed separately during this time.
CPT 77385 is often appropriate for breast or prostate cancer diagnoses because critical structures are not in the immediate area. CPT 77386 may be appropriate for the left breast, depending on the location of the tumor and what tissues may be impacted.
A special teletherapy port plan is a dosimetry plan and must NOT be billed in addition to another dosimetry plan (CPT® 77306-77307, 77295, 77301) for the same work performed.
Monitor unit calculations are not billable with CPT® 77306, 77307 and 77321. Calculations are considered bundled into these planning codes and not separately billable.
The process of care in radiation oncology is a series of complex steps that can be broken down into six phases: Patient consultation; Preparing for treatment; Medical radiation physics, dosimetry, treatment devices and special services; Radiation treatment delivery;
Simulation is the process of defining relevant normal and abnormal target anatomy and acquiring the images and data necessary to develop the optimal radiation treatment process, without actually delivering a treatment.
Clinical treatment planning codes (CPT codes 77261-77263) are the professional charges for the physician to integrate the patient’s overall medical condition and extent of disease and to formulate a plan of therapy for the patient.
Within clinical treatment planning, the radiation oncologist develops the specific parameters of the therapeutic management plan, including the overall clinical, physical and technical aspects of radiation treatment required for safe and effective therapy for each patient .
In the hospital setting under the Hospital Outpatient Prospective Payment System (HOPPS), +77293 is not separately reimbursable. However, it is extremely important to still report +77293 (when performed) separately for tracking purposes and for non-governmental payers that may not conform to HOPPS guidelines.
Radiation physics services (CPT codes 77300-77334, 77399) include a professional component (PC) and a technical component (TC). These services are covered following the same logic as other radiologic services that include PC and TC components.
This section allows coverage and payment of those services that are considered to be medically reasonable and necessary.
Frequency is considered excessive when services are performed more frequently than generally accepted by pe ers and the reason for additional services is not justified by documentation.
Aetna Denial of 77014#N#In the ASTRO letter, it specifically states that Aetna is requesting 77387 for modifier 26. If we bill only the Technical component for one of our locations, would the 77387-TC apply or is it only for professional and global?
Has anyone had any luck with these? I saw on the ASTRO website they published a letter from Aetna stating they are keeping their current policy but per CPT the appropriate code to use is 77387-26.
After appeals and disputes with provider representatives and medical directors, Aetna refused to accept 77014. The reimbursement for 77387 is significantly less than 77014, therefore, we came to an agreement to bill 77387, and Aetna agreed to reimburse 77387 with a rate comparable to 77014.