Daily Practice

Computed tomography guidance for placement of radiation therapy fields (77014)

CT Guidance Not Reported Separately with Simulation

Effective January 1, 2014, providers will no longer separately report CT guidance, represented by CPT® code 77014 (Computed tomography guidance for placement of radiation therapy fields) when reporting simulation services represented by codes 77280-77290 and code 77295 (Therapeutic radiology simulation-aided field setting; 3-dimensional). The codes have been revised to reflect current practice, and since the use of CT guidance is integral to the simulation procedure it should no longer be reported separately. The value of the professional and technical components of CT guidance is now captured within the simulation service.

Guidance for Reporting CPT Code 77014 with Simulation Codes

Since the development of the simulation codes, there have been significant changes in the process of care for physician and other qualified health care professionals, as well as the nature of the equipment utilized. For example, fluoroscopic simulators have largely been replaced with dedicated CT scanners and related work stations. As a result, CPT code 77014 is now included in the simulation codes. At the time of simulation, CPT code 77014 may not be reported by the provider in either the freestanding or the hospital setting.

In 2014, CPT 77295 has been reassigned and is now grouped under Medical Radiation Physics, Dosimetry, Treatment Devices and Special Services rather than simulations. Nevertheless, this same rule of not reporting CPT code 77014 when reporting CPT code 77295 also applies.

The inclusion of CT guidance within the simulation service is documented in the definition of simulation which was added to the 2014 CPT book. The definition states, "Simulation is the process of defining relevant normal and abnormal target anatomy, and acquiring the images and data necessary to develop the optimal radiation treatment process for the patient."

CPT Code Description IGRT-Specific Guidelines Supervision Requirements
77014 Computed tomography guidance for placement of radiation therapy fields Used with CT-based systems (i.e., integrated cone beam CT, CT/linear accelerator on rails, tomotherapy). Direct

Disclaimer: The opinions referenced are those of members of the ASTRO Code Utilization and Application Subcommittee based on their coding experience and they are provided, without charge, as a service to the profession. They are based on the commonly used codes in radiation oncology, which are not all inclusive. Always check with your local insurance carriers, as policies vary by region. The final decision for coding for any procedure must be made by the physician, considering regulations of insurance carriers and any local, state or federal laws that apply to the physicians practice. ASTRO nor any of its officers, directors, agents, employees, committee members or other representatives shall have any liability for any claim, whether founded or unfounded, of any kind whatsoever, including but not limited to any claim for costs and legal fees, arising from the use of these opinions.  

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