Loading...Loading...Policy No: 110
Date of Origin: 04/01/2021
Section: Administrative
Last Reviewed: 08/01/2024
Last Revised: 08/01/2024
Approved: 08/08/2024
Effective: 09/01/2024
Policy applies to: Group and Individual & Medicare Advantage
This policy applies to all facilities with Outpatient Prospective Payment System (OPPS) pricing.
Ambulatory Payment Classification (APC): The government's method of paying facilities for outpatient services for the Medicare program
IMRT Planning: Developing an IMRT plan of treatment
Intensity modulated radiotherapy (IMRT): A form of radiation therapy that conforms closely to the targeted tumor shape and allows higher doses of radiation to be delivered while minimizing toxicity to surrounding healthy tissues.
Outpatient Prospective Payment System (OPPS): The system through which Medicare decides how much money a hospital or community mental health center will get for outpatient care.
When IMRT is furnished in a hospital outpatient department that is paid under the hospital Outpatient Prospective Payment System (OPPS), Current Procedural Terminology (CPT®) codes 77014, 77280, 77285, 77290, 77295, 77306, 77307, 77316, 77317, 77318, 77321, 77331, and 77370 are included in the Ambulatory Payment Classification (APC) payment for CPT code 77301 -IMRT planning.
The listed codes are not separately reimbursable when billed within 14 days prior to, or as part of, the development of the IMRT plan, CPT code 77301. The payment for these services is included in the payment associated with the IMRT planning, even if the individual services are performed on different dates of service than the IMRT planning.
IMRT Procedure Codes | |
|---|---|
77014 | Computed tomography guidance for placement of radiation therapy fields |
77280 | Therapeutic radiology simulation-aided field setting; simple |
77285 | Therapeutic radiology simulation-aided field setting; intermediate |
77290 | Therapeutic radiology simulation-aided field setting; complex |
77295 | 3-dimensional radiotherapy plan, including dose-volume histograms |
77306 | Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s) |
77307 | Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s) |
77316 | Brachytherapy isodose plan; simple (calculation(s) made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s) |
77317 | Brachytherapy isodose plan; intermediate (calculation(s) made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s) |
77318 | Brachytherapy isodose plan; complex (calculation(s) made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s) |
77321 | Special teletherapy port plan, particles, hemibody, total body |
77331 | Special dosimetry (e.g., TLD, microdosimetry) (specify), only when prescribed by the treating physician |
77370 | Special medical radiation physics consultation |
Centers for Medicare & Medicaid Services (CMS), Intensity-Modulated Radiation Therapy (IMRT) Planning Services Editing, MLN Matters Number: SE18013
Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.