Tuesday, June 22, 2010

Procedure 77427 - WEEKLY RADIATION THERAPY

WEEKLY RADIATION THERAPY

Coverage and Codes: Medicare Part B only pays for the professional component of weekly
radiation services and only for the weekly management code of 77427. The daily treatment
management codes have been eliminated from the Procedure-4. Daily treatment management and
port film interpretation services are considered to be part of weekly radiation management.


When billing weekly management treatments, indicate the start date of the weekly course as
the date of service and indicate the units or numbers of service in the corresponding days/units
field (i.e., “5” fractions).
Definition of Weekly Treatment: A weekly unit of treatment is equal to five fractions, or
treatment sessions, regardless of the actual time period in which the services are furnished. It is
not necessary that the radiation therapist personally examine the patient during each fraction for
the weekly treatment management code to be payable.

Multiple fractions representing two or more treatment sessions furnished on the same day may
be counted as long as there has been a distinct break in therapy sessions and the fractions are
of the character usually furnished on different days. Code 77427 is also reported if there are
three or four fractions beyond a multiple of five at the end of a course of treatment; one or two
fractions beyond a multiple of five at the end of a course of treatment are not reported
separately. The professional services furnished during treatment management typically consist
of: Review of port films, review of dosimetry, dose delivery, and treatment parameters; review
of patient treatment setups; examination of patient for medical evaluation and management
(e.g., assessment of the patient’s response to treatment, coordination of care and treatment,
review of imaging and/or lab test results.)

For example:

18 fractions = 4 weekly units
62 fractions = 12 weekly units
8 fractions = 2 weekly units
6 fractions = 1 weekly unit

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