5 Jul 2017

Radiation Oncology CPT Codes


Treatment of cancer using radiation (ionizing radiation such as megavoltage X-rays or radionuclide’s).

There are two types of radiation therapy,
            1.    Teletherapy (or) external beam radiation therapy,

            2.    Brachytherapy (or) internal radiation therapy.

Treatment includes:
           1.    Initial consultation
           2.    Clinical treatment planning
           3.    Simulation
           4.    Medical radiation physics
           5.    Dosimetry, treatment devices, special services
           6.    Clinical treatment management procedures

Normal follow-up care and three months following its completion

Initial consultation
    Evaluation and Management

Clinical treatment planning
·        Interpretation of special testing
·        Tumor localization
·        Treatment volume determination
·        Treatment time/dosage determination
·        Choice of treatment modality determination of number of field
·        Selection of appropriate treatment devices

A.  Simple – Single treatment area / No block / single port
B.    Intermediate  - 2 separate treatment area / multiple blocks / converging port
C.  Complex  - 3 or more separate treatment area / highly complex blocking / tangential port

CPT 77261 – simple

CPT 77262 – Intermediate

CPT 77263 – Complex, Therapeutic radiology treatment planning.

Billing and Coding Guidelines:       
     Treatment planning is a one-time charge per course of therapy.
·        Billing for multiple treatment plans for a single course of treatment is not allowed.
          This is a professional service only and the physician is responsible for all the technical aspects of the treatment planning process.- CMS

     Simulation is the process of target setting by using diagnostic imaging equipments like CT, MRI or fluoroscopy.
     Code selection is based on complexity or number of treatment area.  Nearby area would not be considered as separate treatment area (Eg. Breast and internal mammary nodes & adjacent supraclavicular fossa are considered as single treatment area) For 2 different treatment area Eg. Patient with multiple bone metastases in tibia and humerus are considered as separate treatment area.
A.  Simple: Single treatment area
B.    Intermediate: two separate area
C.  Complex: Three or more treatment area (or) If any of the following are involved (Particle, rotation or arc therapy, complex blocking or custom shielding blocks, Brachytherapy stimulation, hyperthermia probe verification, any use of contrast materials.

CPT 77280 – Simple
CPT 77285 – Intermediate
CPT 77290 – Complex, therapeutic radiology simulation aided field setting.

CPT 77293 + add on code for respiratory motion management simulation. This must be reported with the primary procedure of either CPT 77295 or 77301 for the same date of service.

The CPT 77293 describes the physician work and resources involved in acquiring a respiratory correlated or 4-D Ct simulation study for conformal planning.

CPT 77295:  3-dimensional radiothreapy plan, including dose-volume histogram

This code includes the procedures done in preparation for use of coplanar therapy beams hence; CPT codes 77280, 77285, and 77290 are not separately payable on the same date.

It also includes the work done for a teletherapy isodose plan, hence CPT codes 77306-77307 should not be billed separately.

Code 77295 may be billed once per treatment course per treatment volume. In those uncommon circumstances, where there is a substantial change in either patient anatomy or tumor conformation and where a second CT data set is required to produce an accurate, efficacious and safe “cone-down” plan, a second 77295 charge may be appropriate. When the physician deems this to be the case, the medical necessity for the second 77295 simulation must be documented. – CMS

CPT 77300: May be reported as many times as the calculations are performed.

The typical course of radiation therapy will require one to six dosimetry calculations, based on the complexity of the patient’s condition.

Teletherapy isodose plan
CPT 77306 – Simple
CPT 77307 – Complex, Teletherapy isodose plan
CPT 77321 – Particles, Hemibody, total body, Teletherapy port plan


CPT 77331: Special dosimetry – may be used more than once per day per treatment course.

Treatment devices, design and construction
CPT 77332 – simple
CPT 77333 – intermediate
CPT 77334 – complex
These codes may be used more than once per day per treatment course.

Medical radiation physics consultation – Technical service only.

CPT 77336: Continuing medical radiation physics consultation (It includes a documented review of the patient’s treatment chart and record to verify that the patient received the prescribed radiation dosage, appropriate positioning and beam orientation and radiation safety)

CPT 77370: For special medical radiation physics consultation when a problem or special situation arises during radiation therapy.

Eg: Computation of dose to the fetus of a pregnant patient undergoing radiation therapy.

Note: CPT 77370 should not be charged when a qualified medical physicist verifies the calculations performed by others or performs the duties of other members of the treatment team.

IMRT (Intensity modulated radiation treatment delivery)

CPT 77385:  Using physical compensatory based IMRT
CPT 77386:  Not using physical compensatory based IMRT

To report professional component of guidance and tracking, use CPT code 77387 with modifier 26.

Radiation treatment delivery – Technical component only, these codes are reported once per treatment session. The claim must document the distinct break between therapies, when billing multiple treatments on the same day.

CPT 77401: Radiation treatment delivery, superficial / ortho voltage per day. (Voltages in the 200-500 kv range)

CPT 77402: Simple, >1 MeV (Single treatment area, 1 or 2 port, fewer simple blocks)
CPT 77407: Intermediate, >1 MeV (2 separate area, 3 or more port, 3 or more simple blocks)
CPT 77412: Complex, >1 MeV (3 or more separate area, tangential port, custom blocking)

Kilo voltage
< 5Mv
6 - 10 Mv
11 - 19 Mv
> 20 Mv

CPT 77417: Port verification images, this code may be used more than once per day per treatment course.

Radiation treatment management

CPT 77427: Reported once for every five fractions (treatment sessions). Payment should only be made after the fifth treatment has been delivered

Note: Multiple fractions representing two or more treatment sessions furnished on the same day may be counted separately as long as there has been a distinct break in therapy and the fractions are of the character usually furnished on different days.

 If there are three or four fractions beyond a multiple of five at the end of a course of treatment, then one unit of radiation therapy management may be billed.

CPT 77431: Radiation therapy management with complete course of therapy consisting of one (1) or two (2) fractions only

Note: This code should not be used for reimbursement of the remaining treatments at the end of a longer course of therapy.