Notification

Radiation Therapy Services (Independence)


Notification Issue Date: 10/21/2019



Policy Attachment


Attachment to Policy # 09.00.56j


Attachment:A

Policy #:09.00.56j

Description:CPT, HCPCS and Revenue Codes

Title:Radiation Therapy Services (Independence)


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.



Brachytherapy
Code
0394T
0395T
77316
77317
77318
77750
77761
77762
77763
77767
77768
77770
77771
77772
77778
77789
77790
77799
C1716
C1717
C1719
C2616
C2634
C2635
C2636
C2637
C2638
C2639
C2640
C2641
C2642
C2643
C2644
C2698
C2699
G0458
S2095


Stereotactic Radiation Therapy
Code
61796
61797
61798
61799
61800
77371
77372
77373
77432
77435
G0339
G0340


Intensity Modulated Radiation Therapy (IMRT)
Code
77301
77338
77385
77386
G6015
G6016


Neutron Beam Radiation Therapy
Code
77423


Intraoperative Radiation Therapy (IORT)
Code
19294
77424
77425
77469


Proton Beam Radiation Therapy
Code
77520
77522
77523
77525


Hyperthermia Treatment
Code
77600
77605
77610
77615
77620


Radiation Treatment Management
Code
77427
77431
77470
77499
G6017


Radiation Treatment Planning
Code
77261
77262
77263
77280
77285
77290
77293
77299


Radiation Treatment Delivery
Code
77401
77402
77407
77412
77417
G6003
G6004
G6005
G6006
G6007
G6008
G6009
G6010
G6011
G6012
G6013
G6014


Radiologic Guidance
Code
77014
77387
G6001
G6002


Medical Radiation Physics, Dosimetry, and Treatment Devices
Code
77295
77300
77306
77307
77321
77331
77332
77333
77334
77336
77370
77399


Therapeutic Radiopharmaceuticals
Code
79005
79101
79403
A9513
A9527
A9530
A9543
A9563
A9564
A9590
A9600
A9604
A9606


Associated Services with Radiation Therapy
Code
19296
19297
19298
31643
32553
41019
49411
49412
55875
55876
55920
57155
57156
58346
76873
76965
A4648
A4650
A9517
C1715
C9725
C9726
C9728


Version Effective Date: 01/21/2020
Version Issued Date: 01/21/2020
Version Reissued Date: N/A

Connect with Us        


2017 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.