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Daily Practice

Image Guided Radiation Therapy (IGRT) Coding Guidance

The Centers for Medicare and Medicaid Services (CMS) continue to require the use of G-codes under the Medicare Physician Fee Schedule (MPFS) for the new treatment delivery, intensity modulated radiation therapy (IMRT), and IGRT codes. 

Many providers and payers will continue to encounter difficulty distinguishing between when to report CPT® codes and when to report G-codes for IGRT services. Additionally, many payers have implemented different reporting requirements for the same image guidance services.

Image Guidance CPT® and HCPCS Codes

CPT code 77387, guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performed; was created in 2015. 

CPT code 77387 did not receive an assigned reimbursement value in the MPFS. Providers billing under Medicare were instructed to report IGRT services using the following Healthcare Common Procedure Coding System (HCPCS) G-codes and CPT code:

  • G6001: Ultrasonic guidance for placement of radiation therapy fields
  • G6002: Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy
  • G6017: Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (e.g., 3D positional tracking, gating, 3D surface tracking), each fraction of treatment
  • 77014: Computed tomography guidance for placement of radiation therapy fields

These codes can also be used to report the professional component (PC) of IGRT services for providers in a hospital setting by attaching the -26 modifier to the codes. Note: G6017 is a technical-only code, therefore the -26 modifier cannot be attached.

Non-Medicare payers, however, have discretion as to whether they will accept the IGRT G-codes or CPT code 77387. Although there is no Medicare-assigned value for CPT code 77387, some private payers have assigned their own value to 77387. In these situations, a provider will report 77387 globally, or by attaching the -26 modifier to 77387 to designate the PC of the code.

IGRT Guidance for Hospitals

CPT® code 77387 was accepted into the Hospital Outpatient Prospective Payment System (HOPPS), therefore hospitals may utilize 77387 for IGRT services.

77387-TC should not be reported with IMRT delivery codes 77385 and 77386.

The technical component (TC) of IGRT code 77387 is bundled into IMRT delivery codes 77385 and 77386. When IGRT is bundled, as with IMRT, the hospital should modify its chargemaster such that the IMRT delivery charges reflect the included IGRT work. In the hospital setting, the professional component (PC) of IGRT should still be reported with IMRT by attaching the -26 modifier to G6001, G6002, 77014 and/or 77387. 

77387-TC should always be reported when image guidance is performed with CPT codes 77402, 77407, and 77412.

Hospitals should report the TC of CPT code 77387 when performed with conventional (non-IMRT, non-SRS/SBRT) radiation treatment delivery. However, 77387-TC is not reimbursed separately in the hospital setting because it is packaged into the Ambulatory Payment Classification (APC) with the treatment delivery service with which it is performed. Reporting 77387-TC is essential because the data is collected by CMS and is utilized in calculating future reimbursement values for IGRT under the HOPPS. Failure to report IGRT-TC when performed with conventional radiation therapy may result in inappropriate reimbursement in future years. IGRT should not be reported in association with CPT code 77401, superficial/orthovoltage treatment delivery.

IGRT Guidance for Freestanding Centers

Most freestanding centers will report claims under the MPFS. Therefore, freestanding offices will typically report G-codes for treatment delivery and IGRT. However, some non-Medicare payers may require the reporting of CPT® codes in freestanding centers under their own fee schedules.

Please see the table below for an outline of IGRT reporting requirements. However, it is extremely important to check with your payer before submitting claims, as requirements and policies vary by payer.

 

Freestanding Setting

Hospital Setting

IGRT with IMRT Delivery

Office bills:

  • IMRT code: G6015 or G6016. If reporting CPT codes: 77385 or 77386
  • IGRT code: G6001, G6002 and/or 77014 (global)

Hospital bills:

  • IMRT code: 77385 or 77386

Physician bills:

  • IGRT code(s): G6001, G6002, and/or 77014 with the -26 modifier attached (PC)

IGRT with Conventional Radiation Treatment Delivery

Office bills:

  • Treatment delivery code: G6003-G6014
  • IGRT code(s): G6001, G6002, and/or 77014 (global)

Physician bills:

  • IGRT code(s): G6001, G6002, and/or 77014  with -26 modifier (PC)

Hospital bills:

  • Treatment delivery code: 77402, 77407 or 77412
  • IGRT code: 77387 with -TC modifier
‚ÄčNote: When performing conventional treatment delivery with IGRT, 77387-TC is not separately reimbursable. However, hospitals should still report 77387-TC separately for tracking purposes and non-HOPPS payers
 

Physician bills:

  • IGRT code(s): G6001, G6002, and/or 77014 with the -26 modifier attached (PC)

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®) 2020, American Medical Association. All Rights Reserved.

CPT is registered trademark of the American Medical Association.