By Jessica Adams, ASTRO Health Policy Analyst
In addition to providing resources to assist practices in submitting accurate claims for reimbursement, ASTRO is actively working with payers on coverage and payment issues. Recently, we received questions regarding reimbursement for radium-223 dichloride (Xofigo) and CMS’ Targeted Probe and Educate program. The following Radiation Oncology Reimbursement Reminder is drawn from our many coding
resources to help practices properly bill for this treatment.
What is the appropriate treatment planning code to use for the delivery of radium-223 dichloride (Xofigo)?
Complex radiation treatment planning (CPT code 77263) is used when the radiation oncologist performs the cognitive work associated with treatment planning and the service meets the definition of complex. The use of radium-223 dichloride meets the criteria for billing CPT code 77263.
What criteria do recovery audit contractors (RACs) use under CMS’ Targeted Probe and Educate (TPE) program?
CMS requested that RACs use National Coverage Determinations (NCDs) when performing an audit, as these determinations are more consistent than Local Coverage Determinations, which vary by Medicare Administrative Contractor.
ASTRO members and their practices should be familiar with the following NCDs:
Members should also review ASTRO’s Coding Guidance
regarding simulation and intensity-modulated radiation therapy (IMRT) planning. The Office of the Inspector General (OIG) issued a report
that found that Medicare overpaid U.S. hospitals an estimated $21.5 million between 2013 and 2015 for simulation (77280, 77290) when performed as part of IMRT planning (77301).
Finally, we have an example of a private payer relieving some administrative burden for radiation oncology practices. Anthem recently removed several Radiation Therapy procedures from their prior authorization list. As of early August, Stereotactic Radiosurgery (SRS), IMRT Planning, IMRT multi-lead collimator (MLC) device and IMRT Treatment Delivery codes no longer require prior authorization. These procedures are all included in ASTRO’s Model Policies
, which outline correct coverage policies for radiation oncology services.
We hope that this guidance helps radiation oncology practices as they navigate billing issues. Do you have billing questions or any other common billing pitfalls? Let us know in the comments, or attend ASTRO’s third Coding and Coverage Seminar
, taking place December 7-8. Registration
is open and filling up fast!
To purchase ASTRO’s Coding Resource, which includes information on updated CPT codes, visit our website
. Or, if you’ve already purchased the Resource, you may access it by logging in to your MyASTRO
account and clicking on Virtual Meetings/Products under My Resources.