Coding Guidance for Radiation oncology coding is often complicated with many nuances, yet applying coding guidance in a consistent manner is critical.
CPT code 77295
Use CPT code 77295 to report 3-dimensional radiothreapy plan, including dose-volume histogram. This code also includes those procedures done in preparation for use of coplanar therapy beams and, therefore, CPT codes 77280, 77285, and 77290 are not separately payable on the same date.
It also includes the work done for a teletherapy isodose plan (CPT codes 77306-77307) and accordingly, codes 77306-77307 should not be billed separately.
Code 77295 may be billed once per treatment course per treatment volume. In those uncommon circumstances, where there is a substantial change in either patient anatomy or tumor conformation and where a second CT dataset is required to produce an accurate, efficacious and safe “cone-down” plan, a second 77295 charge may be appropriate. When the physician deems this to be the case, the medical necessity for the second 77295 simulation must be documented.
CPT code 77300
Basic radiation dosimetry, calculation, central axis depth, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, as required during course of treatment but only when prescribed by the treating physician. This service is considered to be medically necessary for each treatment port and if a patient has off-axis calculations, calculations for different depth doses, different volumes of interest, secondary film dosimetry, abutting volumes of interest, or any other situation requiring individual point calculations of radiation dosage. Changes in a patient’s weight or girth during the course of radiation treatment may necessitate dosimetry recalculation. This procedure need not be routinely performed each time the patient is treated. 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. However, radiation treatments to the head/neck, prostate and Hodgkin’s disease may require eight or more calculations.
CPT code 77306
Use CPT code 77306 for a simple teletherapy isodose plan when there are one or two unmodified ports directly at one volume of interest. This code includes basic dosimetry calculations.
CPT code 77307
Use CPT code 77307 for a complex teletherapy isodose plan when multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beams, or special beam considerations will be used. This code includes basic dosimetry calculations.
CPT code 77321
Special teletherapy port plan, particles, hemi-body, total body uses CPT code 77321. Only one plan should be billed per treatment course.
CPT code 77331
Special dosimetry (e.g., TLD, microdosimetry),CPT code 77331 is considered medically necessary once per port when the physician determines that it is necessary to have a measurement of the amount of radiation that a patient has actually received at a given point, with the final results being utilized to accept or modify the current treatment plan. This procedure will generally be reimbursed one time per port per course of treatment when prescribed by the treating physician. The monitoring devices utilized for measuring and monitoring can include thermoluminescent dosimeters (TLD), solid state diode probes, special dosimetry probes, or film dosimeters. The physician must specify the type of special dosimetry. When special dosimetry is employed, the usual frequency will vary from one to six, consistent with the number of dose calculations. Frequency in excess of the upper end of this range will require appropriate documentation in the medical record. This code (CPT 77331) may be used more than once per day per treatment course.
CPT codes for IMRT Treatment Devices
- CPT Code 77332 treatment devices, design and construction; simple (simple block, simple bolus)
- CPT Code 77333 treatment devices, design and construction; intermediate (multiple blocks, stents, bite blocks, special bolus)
- CPT Code 77334 treatment devices, design and construction; complex (irregular blocks, special shields, compensators, sedges, molds or casts)
Devices
- CPT code 77338 Multi-Leaf Collimator (Mlc) device(s) for Intensity Modulated Radiation Therapy (IMRT), design and construction per IMRT plan. Do not report 77338 more than once per IMRT plan. Do not report 77338 in conjunction with G6016, compensator based IMRT.
- G6016 Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator convergent beam modulated fields, per treatment session. For treatment planning, use 77301. Do not report G6016 in conjunction with 77401, G6003-G6014 or G6015.
CPT codes for IGRT
CPT Code G6001
Ultrasonic guidance for placement of radiation therapy fields
CPT Code 77014
Computed tomography guidance for placement of radiation therapy fields
CPT Code G6002
Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy
CPT Code G6017
Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (e.g.,3-D positional tracking, gating, 3-D surface tracking), each fraction of treatment
Bundling
The following CPT codes were used as building blocks during the development of the IMRT planning CPT code. They are components of CPT code 77301 and therefore should not be separately coded or billed on the same day of service.
CPT Code 76370 / 77014 (deleted/current)
Computerized axial tomography guidance for placement of radiation therapy fields
CPT Code 76375/ 76376 (deleted/current)
Coronal, sagittal, multiplanar, oblique, three-dimensional and/or holographic reconstruction of computerized axial tomography, magnetic resonance imaging, or other tomography modality
CPT Code 77295
Therapeutic radiology simulation-aided field setting; Three-dimensional simulation
CPT Code 77331
Special radiation dosimetry
Submitting Documentation
Part A
Do not attach information to the original claim. Below is the list from the Part A website of what documentation is requested when reviewing radiation therapy:
- A detailed itemization and supporting documentation for all services billed
- Documentation of history of illness being treated
- Documentation of physician involvement
- Physician order(s) for treatment including current dosage
- Documentation to support all services billed were provided
- Dosimetry reports
- Physicist reports
- Simulation reports
- Oncology reports
- Documentation of each treatment billed
- Copy of radiological report or physician’s interpretation
- Documentation of any contrast material provided
Part B
Do not attach information to the original claim. Additional information can be placed in Item 19 on the 1500 form or its electronic equivalent when needed.
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