PROCEDURE CODE 77401, 77750, 77300 AND 77399 - Radiation physical services

 Radiation Treatment Delivery (Procedure  code 77401 - 77417)

A/B MACs (B) 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. A/B MACs (B) pay for Procedure  code 77417 (Therapeutic radiology port film(s)) on a weekly (five fractions)
basics.


Clinical Brachytherapy (Procedure  Codes 77750 - 77799)


A/B MACs (B) 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, A/B MACs (B) 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 brachy therapy 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)


A/B MACs (B) 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, A/B MACs (B) 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 A/B MACs (B) in settings in which only technical component is are payable.

Weekly Radiation Therapy Management (Procedure code 77419 - 77430)

A/B MACs (B) must pay for a physician’s weekly treatment management services under code 77427. Billing entities must indicate on each claim the number of fractions for which payment is sought. A weekly unit of treatment management is equal to five fractions or treatment sessions. A week for the purpose of making payments under these codes is comprised of five fractions 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. If, at the final billing of the treatment course, there are three or four fractions beyond a multiple of five, those three or four fractions are paid for as a week. If there are one or two fractions beyond a multiple of five, payment for these services is considered as having been made through prior payments.


EXAMPLE: 18 fractions = 4 weekly services

62 fractions = 12 weekly services

8 fractions = 2 weekly services

6 fractions = 1 weekly service

If billings have occurred which indicate that the treatment course has ended (and, therefore, the number of residual fractions has been determined), but treatments resume, adjust A/B MAC (B) payments for the additional services consistent with the above policy.

EXAMPLE: 8 fractions = payment for 2 weeks

2 additional fractions are furnished by the same physician. No additional Medicare payment is made for the 2 additional fractions.

A. SNF Treatment Management Delivery Services

A SNF may not bill weekly treatment management services for its outpatients (codes 77419, 77420, 77425, 77430, and 77431). Instead, the SNF should bill for radiation treatment delivery (codes 77401 - 77404, 77406 - 77409, 77411 - 77414, and 77416). Also, SNFs bill for therapeutic radiology port film (code 77417), which was previously a part of the weekly services. They enter the number of services in the units field.

Billing Procedure code 77427 - Weekly radiation therapy management

Weekly Radiation Therapy Management (Procedure code 77419 - 77430)

Carriers must pay for a physician’s weekly treatment management services under code 77427. Billing entities must indicate on each claim the number of fractions for which payment is sought.

A weekly unit of treatment management is equal to five fractions or treatment sessions. A week for the purpose of making payments under these codes is comprised of five fractions 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. If, at the final billing of the treatment course, there are three or four fractions beyond a multiple of five, those three or four fractions are paid for as a week. If there are one or two fractions beyond a multiple of five, payment for these services is considered as having been made through prior payments.

EXAMPLE: 18 fractions = 4 weekly services
62 fractions = 12 weekly services
8 fractions = 2 weekly services
6 fractions = 1 weekly service

If billings have occurred which indicate that the treatment course has ended (and, therefore, the number of residual fractions has been determined), but treatments resume, adjust carrier payments for the additional services consistent with the above policy.

EXAMPLE: 8 fractions = payment for 2 weeks
2 additional fractions are furnished by the same physician. No additional Medicare payment is made for the 2 additional fractions.

A. SNF Treatment Management Delivery Services

A SNF may not bill weekly treatment management services for its outpatients (codes 77419, 77420, 77425, 77430, and 77431). Instead, the SNF should bill for radiation treatment delivery (codes 77401 - 77404, 77406 - 77409, 77411 - 77414, and 77416).

Also, SNFs bill for therapeutic radiology port film (code 77417), which was previously a part of the weekly services. They enter the number of services in the units field.