IMRT Planning (77301)
CMS has updated previous guidance on the CPT codes that may be reported with 77301 for developing an IMRT treatment plan. Effective January 1, 2017, the following guidance will apply to CPT code 77301 in both the hospital and the freestanding setting.
Payment for the services identified by CPT codes 77014, 77280, 77285, 77290, 77295, 77306, 77307, 77321 and 77331, are included in the payment for CPT code 77301 (IMRT planning). These codes should not be reported in addition to CPT code 77301 when provided prior to or as part of the development of the IMRT plan. Since January 2017, CPT code 77280 (simulation aided field setting) should not be reported for verification of the treatment field during the course of IMRT.
CPT code 77370 cannot be used for a QA or development of the treatment plan. There may be certain clinical scenarios where the physician will need a special physics consult after the development of the plan.
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.
All CPT code descriptors have been taken from Current Procedural Terminology (CPT®) 2015, American Medical Association. All Rights Reserved.
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