Thursday, October 14, 2010

PROCEDURE CODE 77401 - 77416 & 77750 - 77799 & 77300 - 77399 Radiation physical services

Radiation Treatment Delivery (Procedure code 77401 - 77417)

Carriers pay for these TC services on a daily basis under Procedure codes 77401-77416 for radiation treatment delivery. They do not use local codes and RVUs in paying for the TC of radiation oncology services. Multiple treatment sessions on the same day are payable as long as there has been a distinct break in therapy services, and the individual sessions are of the character usually furnished on different days. Carriers pay for Procedure code 77417 (Therapeutic radiology port film(s)) on a weekly (five fractions) basis.

Clinical Brachytherapy (Procedure Codes 77750 - 77799)

Carriers must apply the bundled services policy to procedures in this family of codes other than Procedure code 77776. For procedures furnished in settings in which TC payments are made, carriers must pay separately for the expendable source associated with these procedures under Procedure code 79900 except in the case of remote after-loading high intensity brachytherapy procedures (Procedure codes 77781-77784). In the four codes cited, the expendable source is included in the RVUs for the TC of the procedures.

Radiation Physics Services (Procedure  Codes 77300 - 77399)

Carriers pay for the PC and TC of Procedure codes 77300-77334 and 77399 on the same basis as they pay for radiologic services generally. For professional component billings in all settings, carriers presume that the radiologist participated in the provision of the service, e.g., reviewed/validated the physicist’s calculation. Procedure codes 77336 and 77370 are technical services only codes that are payable by carriers in settings in which only technical component is are payable.

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