Radiation oncology is the specialty of medicine that utilizes high-energy ionizing radiation in the treatment of malignant neoplasms and certain non-malignant conditions. It uses several distinct therapeutic modalities; teletherapy, brachytherapy, hyperthermia, and stereotactic radiation. These may be directed at either malignant or benign lesions.

Radiation oncology services are considered medically reasonable and necessary when the following conditions outlined in this policy are indicated and documented in the patient’s medical records.

Payment is limited to services furnished in office, inpatient hospital, and outpatient hospital. A freestanding radiation oncology center is considered, for billing purposes, an office.

Tumor Mapping and Clinical Treatment Planning (Codes 77261-77263)
Clinical treatment management and tumor mapping are crucial to identifying the location, extent, and volume of tumor(s) to be treated and all critical structures surrounding them. The physician plans the appropriate course of radiation therapy, which will allow for maximum benefit while protecting surrounding tissues and structures. Clinical treatment planning may involve ordering and interpreting special tests such as lymphangiography, CT scan, MR scan and/or surgical exploration with biopsy and markers placed for the purpose of treatment planning and tumor localization.

Treatment planning (codes 77261–77263) is a one-time service per course of therapy. Multiple treatment plans for a single course of treatment are not medically necessary.

This is a professional service only and the physician is responsible for all of the technical aspects of the treatment planning process.

Therapeutic Radiology Simulation - Aided Field Setting (Codes 77280-77295)
The typical course of radiation therapy will require from one to three simulations. However, no more than one simulation may be reported on any given day.

Simple radiation therapy field setting applies to:

• Single volume of interest with either a simple port or parallel opposed ports;
• Simple or no blocking;
• Block verification simulation;
• Resimulation at a later date to verify the accuracy of custom blocks, prior to beginning a treatment is considered a simple simulation.

Intermediate radiation therapy field setting applies to:

• Simulation of three or more converging ports, or two separate volumes of interest;
• Multiple blocks when clinically necessary;
• Tangential ports without devices or with a single pair of pre-manufactured wedges.

Complex radiation therapy field setting applies to:

• Three or more volumes of interest;
• Rotation or arc therapy;
• Complex blocking or custom made shielding blocks or compensators, when clinically necessary;
• Any use of contrast media (e.g. body cavity, GI tract, or intravascular) when clinically necessary to define anatomic structures and volumes of interest;
• Tangential ports with multiple devices;
• Simulation for brachytherapy.

Three dimensional radiation therapy field setting involves three-dimensional computer-generated reconstruction of tumor volume and surrounding critical normal tissue structures from direct CT scan and/or MRI data in preparation for non-coplanar or coplanar therapy. The simulation uses documented 3-D beam’s eye view volume-dose displays of multiple or moving beams. Documentation with 3-D volume reconstruction and dose distribution is required. Three-dimensional simulation and treatment is clinically warranted when one or more of the following conditions exist:

1. The volume of interest is irregular and in close apposition to normal structures that must be protected.
2. The volume of interest is in such a location that it cannot be clearly identified under conventional fluoroscopic guidance.
3. The final boost volume of interest must be constructed to the exact tumor volume with its irregular configuration.
4. Multiple conformed portals are necessary to cover the volumes of interest with close margins and protect immediately adjacent normal structures.
5. Beams "eye view” of multiple portals must be established for conformal treatment delivery.
6. An immediately adjacent region has been irradiated and abutting portals must be established with high precision.

Radiation oncology simulation is defined as the process of determining and establishing the radiation therapy treatment portals to a specific treatment volume. Simulation is accomplished through the use of equipment such as dedicated simulator, linear accelerator, cobalt unit, ortho voltage X-ray machine, diagnostic X-ray fluoroscopy unit, or other equipment used to establish areas to be treated without delivering radiation treatment. Ordering and interpreting special tests may be required to assist in the field settings.

Following treatment planning, simulation is used to actually direct the treatment beams to the specific volumes of interest. Simulation may be carried out on a dedicated conventional simulator or CT scanner, radiation therapy treatment unit (e.g., linear accelerator), or using diagnostic imaging equipment (e.g., fluoroscopy, CT, MR).

The complexity of simulation is based on the number of ports, volumes of interest, and the inclusion and type of treatment devices. However the number of films taken per treatment, the modality from which images for simulation are obtained, and the use of fluoroscopy are not determinants of complexity. Portal changes based on unsatisfactory initial simulation(s) are not reported as additional simulations. Additional simulations may be necessary during treatment in order to account for changes in port size, boost dose, or tumor volume. However, minor changes in port size without changes in beam or without clinical justification do not warrant an additional charge or a higher level of complexity.

The inclusion of treatment devices in the simulation process typically increases the complexity. Simulation without the inclusion of devices or with any pre-made devices (e.g., blocks, immobilization) is considered simple. Custom devices elevate complexity when clinically appropriate. Documentation of simulation requires a written record of the procedure and hard copy of electronic images and evidence of image review by physicians including signature or initials and data review.

Basic Radiation Dosimetry Calculation (Code 77300)
Radiation therapy dose plan is medically necessary for:

• Each treatment port and, if a patient has off-axis calculations, calculations for different depth doses, different volumes of interest, secondary film dosimetry, abutting volumes of interest, or any other situation requiring individual point calculations of radiation dosage.
• Changes in a patient’s weight or girth during the course of radiation treatment may necessitate dosimetry recalculation.
• This procedure need not be routinely performed each time the patient is treated.

Basic dosimetry calculations may be reported as many times as the calculations are performed. The typical course of radiation therapy will require from one to six dosimetry calculations, depending on the complexity of the patient’s problem.

Intensity Modulated Radiotherapy Treatment Planning (IMRT)(Codes 77301 and 77338) 
IMRT is an advanced form of external beam treatment that utilizes a more complex version of 3-dimensional conformal therapy than standard conventional three-dimensional treatment. Necessary components include:

• CT/MRI computer reconstruction in a 3-D format;
• A delivery system capable of dynamic multileaf collimation to deliver multiple beams of highly focused radiation doses.

IMRT optimizes inverse treatment planning as opposed to forward treatment planning. The radiation oncologist and physics department decide the tumorcidal dose, acceptable dose to surround structures, the treatment target, then the computer plan is worked backwards to design ports, and beam profiles that yield desired results. While IMRT may be utilized as a single modality or a component of the total, it is not a replacement for conventional or 3-D conformal radiation delivery in all situations.

An IMRT plan includes dose-volume histograms for target and critical structure partial tolerance specifications. Dose plan is optimized using inverse or forward planning technique for modulated beam delivery (e.g., binary, dynamic MLC) to create highly conformal dose distribution. Computer plan distribution must be verified for positional accuracy based on dosimetric verification of the intensity map with verification of treatment set-up and interpretation of verification methodology.

External Beam Isodose Plan (Codes 77305-77315)
Radiation therapy dose plan is considered medically necessary for a given course of radiation therapy to a specific volume of interest.

The typical course of radiation therapy will require from one to three isodose plans. Usually only one plan per volume of interest will be sufficient, even though some patients may require multiple teletherapy plans during the course of therapy. Situations that may require an extra teletherapy plan include the need to change the machine or the volume of interest. Toward the end of treatment, due to clinical variations of the patient, another plan may be required.

Special Teletherapy Port Plan (Code 77321)
Radiation therapy port plan is considered medically necessary only when a plan for a special beam consideration is required for the treatment of a neoplasm, such as the use of electrons or heavy particles.

A teletherapy isodose plan may be medically necessary with a special teletherapy port plan.

Brachytherapy Isodose Calculation (Codes 77326-77328)
Brachytherapy is used to improve control of local disease, treat areas at high risk for recurrence of malignancy, preserve vital organ function and minimize normal surrounding tissue damage.

Appliances such as gynecological applicators, afterloading tubes, template needles, etc., are first surgically inserted by the radiation oncologists in, on or around the tumor. Brachytherapy implants may be temporary or permanent, depending upon the type of tumor and the isotope used. Following insertion of the applicators, images are obtained for isodose calculation of the actual implant sources or using non-radioactive material in the applicator. Isodose calculations are then made which determines the amount of radiation that will be absorbed by the tumor per minute or hour. From this calculation, the treatment course can be modified if necessary by increasing or decreasing the patient’s exposure time to the radioisotope.

Intravascular brachytherapy may be indicated in the patient with signs or symptoms of in-stent restenosis of the coronary artery, when the restenosis is due to an exaggerated healing response within a previously stented coronary artery/coronary graft vessel.

The definition of the levels of complexity of conventional clinical brachytherapy relates directly to the number of sources or ribbons utilized in the procedure.

Special Dosimetry (Code 77331)
Special radiation dosimetry is considered medically necessary once per port when the physician determines that it is necessary to have a measurement of the amount of radiation that a patient has actually received at a given point with the final results being utilized to accept or modify the current treatment plan.

Special radiation dosimetry is not to be routinely performed each time the patient is treated. It would be expected that the utilization of this procedure would correspond with the level of complexity of the clinical treatment planning services provided for the patient.

When special dosimetry is employed, the usual frequency will vary from one to six.

The monitoring devices utilized for measuring and monitoring can include thermoluminescent dosimeters (TLD), solid state diode probes, special dosimetry probes, or film dosimetry.

Treatment/Immobilization Devices (Codes 77332-77334)
Per the American College of Radiology’s publication in the User’s Guide for the Radiation Therapy Relative Value Scale, “The plural that is included under block(s), mold(s), cast(s), etc., is simply a generic “(s)” indicating a family of choices rather than a multiplicity of items.”

The typical course of radiation therapy will justify from one to five charges for devices. Complex IMRT treatments may require more than five devices.

Multiple treatment devices may be medically necessary during a course of therapy when documentation substantiates multiple volumes of interest/portals, the use of custom-made devices, and/or the necessity of replacement devices.

Simple treatment devices include any of the following:

• Simple port blocks which include one or two hand positioned pre-made blocks;
• Simple pre-fabricated bolus that is capable of being shaped for an individual patient;
• Independent jaw motion or asymmetric collimation.

Intermediate treatment devices include any of the following:

• Multiple port blocks which include three or more pre-made blocks such as comer pelvis blocks, beam splitter blocks, or midline spinal cord blocks;
• Stents;
• Bite blocks; or
• Fabricated single patient use special bolus.

Complex treatment devices include any of the following:

• Customized blocks (low temperature alloy);
• Customized compensators;
• Wedges;
• Molds or casts,
• Multi-leaf collimator; or
• Intensity modulated therapy.

Medical Radiation Physics Consultation (Code 77336)
Continuing medical physics consultation is specific to the review of the weekly radiation treatment plan. This service ensures that the treatment administered conforms to the specifications of the prescribing physician. This service 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. This procedure is reported once for every five consecutive treatments delivered.

Special Medical Radiation Physics Consultation (Code 77370) 
Special medical radiation physics consultation is medically necessary when a problem or special situation arises during radiation therapy. A detailed written report describing the problem to be given to the requesting physician, is required.

Stereotactic Radiosurgery Radiation Treatment Delivery (Codes 77371-77373)
Stereotactic radiosurgery (SRS) is a highly precise form of radiation therapy that delivers a single high-dose or sometimes smaller, multiple doses of radiation beams that converge on the specific area of the brain where the tumor or other abnormality resides.

SRS does not actually remove the tumor; rather, it distorts the DNA of tumor cells causing these cells to lose their ability to reproduce.

SRS treatment is often completed in a one-day session (codes 77371 and 77372), although physicians sometimes recommend a fractionated treatment, in which treatments are given over a period of days or weeks. This is referred to as stereotactic radiation therapy (code 77373).

There are three forms of SRS, each using different instruments and sources of radiation:

• Gamma knife uses beams of highly focused gamma rays. Gamma knife is ideal for treating small to medium size lesions or tumors within the brain.
  
  
• Linear-accelerator (LINAC) delivers high-energy x-ray photons or electrons in a curving path around the patient’s head. The linear accelerator can perform radiosurgery on larger tumors in a single session or during multiple sessions, which is called fractionated stereotactic radiotherapy.
  
  
• Particle beam (proton or cyclotron) therapy is a radiation treatment modality that delivers high-dose radiation to a localized site. Protons, being particles instead of X-rays, slow down faster than photons. They deposit more energy as they slow down, culminating in a peak (called a Bragg peak). This allows the majority of radiation to be delivered to the target site with less scattering of radiation around and beyond to the adjacent normal tissues.

Radiation Treatment Delivery (Codes 77401-77416, 77418, 77421, and 0073T)
Radiation treatment delivery recognizes the technical component and the various energy levels administered.

Portal Verification Film(s)(Code 77417)
Port film verification is a technical component only procedure and does not carry a professional physician component. No modifier is required for these services. The review and interpretation of port films is considered part of the weekly clinical treatment management by the physician.

Radiation Treatment Management (Codes 77427, 77431, 77432, and 77435) 
The professional services furnished during treatment management typically consists of:

• Review of port films;
• Review of dosimetry, dose delivery, and treatment parameters;
• Review of patient treatment set-up;
• Examination of patient for medical evaluation and management (e.g., assessment of the patient’s response to treatment, coordination of care and treatment, review of imaging and/or lab test results)

Single session stereotactic radiosurgery is a procedure completed in a single day. It usually involves 2-4 hours of time by the neurosurgeon and may involve 5-6 hours of time by the radiation oncologist and physicist. Multiple session stereotactic radiosurgery involves a prescribed dose of radiation in a series of small doses over multiple sessions to larger and/or multiple sites. Stereotactic radiosurgery is appropriate for the treatment of certain malignant and benign neoplasms of the brain, cranial nerves, meninges, arteriovenous malformations of cerebral vessels, and other non-neoplasmatic conditions.

Gamma knife ventalis intermedialis thalamotomy and posteroventral pallidotomy have been shown to be safe and effective treatment options for movement disorders. A small subset of patients with Parkinson’s disease, essential tremor, or other disabling tremor who have been evaluated by a neurologist and determined to be refractory to standard medical therapy will be covered. Stereotactic radiosurgery provides an alternative to conventional surgical stereotactic thalamotomy in patients with concomitant conditions such as a coagulopathy, severe cardiac or respiratory disease or psychological inability to tolerate the conventional awake procedure.

Special Treatment Procedures (Code 77470)
Special radiation treatment procedures are medically necessary when additional physician effort and work is required for the special procedures of hyperfractionation, total body irradiation, per oral or transvaginal cone use, brachytherapy, concurrent hyperthermia, planned combination with chemotherapy or other combined modality therapy, stereotactic radiosurgery, intra-operative radiation therapy, and any other special time consuming treatment plan.

This service is not intended to be used because a patient has another ongoing medical diagnosis such as diabetes, C.O.P.D., or hypertension.

High-dose Rate (HDR) Brachytherapy (Codes 77785–77787)
High-dose rate (HDR) brachytherapy is delivered at a rate of 10-to 100cGY per minute. HDR brachytherapy is only temporary and sometimes referred to as remote afterloading. HDR brachytherapy can be used with intracavitary to interstitial types of brachytherapy applications. Codes are based on the number of catheters or channels used in the treatment.

Reasons for Noncoverage

Radiation therapy provided for ineligible conditions will be denied as not medically necessary. A provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement, in the form of a Pre-Service Denial Notice, should be maintained in the provider's records.

Services performed for excessive frequency are not medically necessary. Frequency is considered excessive when services are performed more frequently than generally accepted by peers and the reason for additional services is not justified by documentation.

Documentation Requirements

The patient's medical record must document the medical necessity of services performed for each date of service submitted on a claim, and documentation must be available on request.

Documentation must include the planned course of therapy, type and delivery of treatment, level of clinical management involved and ongoing documentation of any changes in course of treatment.

A patient referral with diagnostic information and request for consultation for radiation oncology must be maintained in the patient’s record and available upon request.

Treatment/Immobilization Devices (Codes 77332-77334) - Additional sets may be allowed only when documentation explains why new or additional devices are necessary. If such documentation is not present, or if the information simply describes the function of the devices, the service will be denied as not medically necessary.

While the typical course of radiation therapy may justify the use of 1-5 devices, complex treatments may require more than 5 devices. Examples of acceptable reasons for additional sets of devices are listed below:

1. The size of the lesion changes;
2. The patient is repositioned;
3. A different volume of interest is treated. (Identify each volume of interest);
4. A boost, change in size of the volume of interest, or coned down beam is used.

Ongoing documentation should include any changes in dosimetry calculations and change in radiation treatment and frequency.

The physician’s documentation must be specific to the number of volumes of interest. The specific location of tumor(s) to be treated must be documented as well as the specific number of ports involved with each volume of interest treated.

All isodose plans must be checked and signed by the medical radiation physicist and the radiation oncologist.

The physician must specify the type of special dosimetry used.

The physician’s documentation within the patient’s medical record must support the specific energy levels reported.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

The following coding guidelines are specific to the Radiation Oncology LCD:

Tumor Mapping and Clinical Treatment Planning (Codes 77261-77263)

• Submit code 77261 when the volume to be treated is clearly defined and easily encompasses the tumor (excludes normal tissue and structures).
  • Simple planning requires no interpretation of special tests and involves no more than one critical structure.
    
    
• Submit code 77262 to report a moderate level of planning difficulty involved and two separate volumes of interest (non-contiguous).
  • Critical or sensitive organs, which need protection usually, are involved.
  • Interpretation of special tests, localization of tumor volume, and not more than two critical structures are involved when planning the optimum course of treatment.
    
    
• Submit code 77263 to report complex treatment planning is involved.
  • Three or more volumes of interest may require treatment.
  • Planning includes interpreting complex tests such as MR and/or CT localization of tumor(s).
  • The cancer is generally complex in its distribution regardless of whether the patient is in early or advanced stages of cancer.
  • Multiple critical areas generally require planning of special protection.
  • Combined therapy may be required for optimum benefit such as brachytherapy, surgery, and chemotherapy.

Therapeutic Radiology Simulation – Aided Field Setting (Codes 77280, 77285, 77290, 77295)

• Code 77295 includes simulation procedures done in preparation for use of coplanar therapy beams and an additional simulation charge (codes 77280, 77285, and 77290) is not separately payable on the same date.
• Code 77295 includes the work done for a teletherapy isodose plan and codes 77305-77315 must not be submitted as separate procedures.
• Code 77295 may be billed once per treatment course per treatment volume.

Teletherapy Isodose Plan (Codes 77305, 77310, 77315)

• Use code 77305 to report one or two ports directed at one volume of interest.
• Use code 77310 when there are three or more ports converging on a single volume of interest. Blocking may be utilized to eliminate the beam from certain portions of the isodose plan and must be verified.
• Use code 77315 to report five or more ports converge on a single volume of interest or when complex blocking and/or wedges are used with any port arrangement.
• Three-dimensional stereotactic isodose planning can be classified as a complex level isodose plan and may be submitted with code 77315, or as part of code 77295, but not with both.

Special Teletherapy Port Plan (Code 77321)

• Submit only one teletherapy port plan per volume of interest.

Brachytherapy Isodose Calculation (Codes 77326-77328)

• It is a generally accepted standard of practice for codes 77326-77328 to be submitted once per application. This procedure may be repeated only if a new implant is inserted.
• Use code 77327 for multiplane calculations on the same day.

Treatment Devices, Designs, and Construction (Codes 77332-77334)

• Submit claims for devices at the beginning of the treatment course and then submit again later in the course of treatment when additional or new devices are required. Payment for one set of treatment devices may be allowed per separate port when radiation therapy is started. However, for billing purposes, a pair of opposing ports, ports that direct parallel beams such as anterior-posterior or left lateral-right lateral pairs are considered, to be one port. This is true regardless of the level of complexity used to create the ports. However, if these devices are significantly different from each other, then the carrier may allow payment for each of the pair of devices. It is the responsibility of the provider to determine the code that most accurately describes the devices employed. At all levels of complexity, the physician must be directly involved in the design, selection, and placement of any of the devices.
  
  
• Submit custom-made immobilization devices at a complex level (code 77334). Samples include, but are not all inclusive to restraining devices such as aquaplast and alpha cradle.
  
  
• Submit a combination of a wedge, a compensator, a bolus, or a port block covering the same treatment portal, as a single complex treatment device charge rather than a separate charge rendered for each of the individual items. If devices of two separate levels of complexity are utilized for the same treatment portal only submit a claim for the one of highest complexity.
  
  
• For treatment devices, designs, and construction (codes 77332-77334), the number of different anatomic sites determines the number of sets or ports involved. Opposing fields (such as AP/PA) represent one set. Each set must be submitted on a claim with the appropriate level of complexity at the onset of therapy.

Medical Radiation Physics Consultation (Codes 77336, 77370)

• Codes 77336 and 77370 only represent technical services and are payable only in settings in which the technical component is payable, i.e., in the freestanding radiation oncology center that employs its own radiation physicist.

Stereotactic Radiation Treatment Delivery (Codes 77371-77373)

• Use codes 77371 or 77372 to report stereotactic radiosurgery (SRS) delivery for the treatment of cerebral lesion(s). A team consisting of the radiation oncologist, neurosurgeon and medical physicist is responsible for supervising the patient positioning and proper alignment of treatment beams involved in SRS. Procedure code 77432 should be included when reporting either code 77371 or 77372.
  
  
• Use code 77373 to report stereotactic body radiation therapy (SBRT) treatment delivery per fraction (not to exceed 5 fractions). Do not report procedure code 77373 in conjunction with codes 77401-77416 and 77418.
  
  
• Use codes 77371 or 77372 to report the technical component of the single-fraction cranial SRS complete course of treatment in one session for the two SRS technical modalities utilized.

Radiation Treatment Delivery (Codes 77401-77416, 77418, 77421, and 0073T)

• Report radiation treatment delivery according to the level of service and the energy used.
• Radiation treatment delivery may be submitted using a date range if the treatments are performed on consecutive days and the energy and level of service are the same. Indicate the total treatment number on the claim.
• If the dates of service are not consecutive or the energy or level of service is not the same, each date of service must be submitted on a separate detail line.
• When more than one treatment is performed on the same day, e.g., hyperfractionation, each treatment should be submitted on a separate detail line.
• Multiple treatment sessions on the same day are payable as long as there has been a distinct break in therapy services and the individual sessions are of the character usually furnished on different days. When submitting a claim for multiple treatments on the same day, the claim must document a distinct break between therapy. Statements such as “A.M. and P.M. treatments” suffice.
• Use code 0073T for compensatory-based beam modulation treatment delivery.
• Do not report code 0073T in conjunction with codes 77401-77416 or 77418.

Portal Verification Film(s) (Code 77417)

• Use code 77417 to report port verification films or electronically generated portal images. These images should agree with the original simulation films and dosimetry. Code 77417 must be submitted with a quantity billed of one.
  
  
• Portal verification films should be reported as one charge per five fractions of therapy, regardless of the number of films required during this time interval or the number of ports involved. If at the end of a treatment course, three or four fractions remain, then one unit of portal verification will be reimbursed. If only one or two fractions remain, then no reimbursement will be made.

Radiation Treatment Management (Codes 77427, 77431, 77432, and 77435)

• Report radiation treatment management in units of five fractions or treatment sessions, regardless of the actual time period in which the services are furnished. The services need not be furnished on consecutive days.
• The date of service must be the beginning date for each unit of five fractions. Do not submit a span of days.
• The quantity billed must be submitted as one for each five fractions. 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 sessions, and fractions are of the character usually furnished on different days.
• Code 77427 may also be reported with a quantity of one when there are three or four fractions remaining at the end of a course of treatment. One or two fractions remaining at the end of a course of treatment are not to be reported.
• Code 77431 is to be used only if a patient’s entire treatment course consists of only one or two fractions.
• Submit code 77431 with the quantity billed regardless if one or two fractions are used.
• Code 77435 and 77421 should not be reported together.

Special Treatment Procedure (Code 77470)

• It is considered acceptable standards of practice for code 77470 to be reported only once during a treatment course and may be submitted with the weekly management codes.
• For the remaining treatment course, a physician should use the appropriate weekly radiation therapy management codes.
• If the treatment course is modified for any reason, the physician should use the appropriate code for the simulation field-setting and dosimetry. Code 77470 should not be used to indicate a modifier treatment course.

High-dose rate (HDR) Brachytherapy (Codes 77785–77787)

• Select the appropriate code based on the number of catheters or channels used in the treatment.
• Use code 77785 to report 1 catheter or channel.
• Use code 77786 to report 2-12 catheters or channels.
• Use code 77787 to report more than 12 catheters or channels.
• The technical component of these procedure codes includes the cost for the radiopharmaceutical.
• Radiation treatment management (code 77427) may be reported every fifth treatment with remote afterloading brachytherapy (HDR) if it is the sole modality of treatment and used on a daily basis the same as conventional radiation treatment.

Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.

Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.

Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider for any claim that lacks the necessary information to process the claim.

Use of these codes does not guarantee reimbursement for radiation therapy. The patient’s medical record must document that the coverage criteria in this policy have been met.

Additional diagnosis codes that may also be used to support medical necessity for procedure codes 77261-77263, 77280-77295, 77300, 77326-77328, 77470, 77785-77787 when performed in conjunction with Brachytherapy: