Notification

Therapeutic Radiology Port Films


Notification Issue Date: 02/17/2010

This is only a notification of the policy that will be effective 05/18/2010. For the current version of the policy click the following link: 09.00.23a Therapeutic Radiology Port Films



Claim Payment Policy


Title:Therapeutic Radiology Port Films

Policy #:09.00.23c

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.

Application of Claim Payment Policy is determined by benefits and contracts. Benefits may vary based on product line, group or contract. Medical necessity determination applies only if the benefit exists and no contract exclusions are applicable. Individual member benefits must be verified.

In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits.When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

Therapeutic radiology port films are covered and eligible for reimbursement consideration by the Company as follows:
    • Therapeutic radiology port films performed in the facility setting are eligible for separate reimbursement.
    • Therapeutic radiology port films performed in the office setting are eligible for separate reimbursement when the billing professional provider owns the equipment.
Therapeutic radiology port films are not eligible for reimbursement to professional providers when performed in the facility setting.

BILLING REQUIREMENTS

Therapeutic radiology port film (Current Procedural Terminology [CPT] code 77417) is a technical component only code. A modifier is not required for this service. Professional claims for CPT code 77417 received with either Modifier 26 or Modifier TC are considered an invalid procedure code/modifier combination. The review and interpretation of port films is considered part of the professional service reported with a radiation treatment management code. Portal verification films should be reported as one charge per five fraction of therapy, regardless of the number of films required during this time interval.

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

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, therapeutic radiology port films are covered under the medical benefits of the Company's products.


Description

Therapeutic radiology port films are radiographs taken at regular intervals to verify correct positioning of all treatment machine portals on individuals undergoing external-beam radiation therapy. The radiographs are taken with the individual interposed between the portal and an x-ray film. The purpose of this film is to demonstrate radiographically that the treatment port, as externally set on the individual, adequately encompasses the treatment volume and at the same time avoids adjacent critical structures.
References

Centers for Medicare & Medicaid Services (CMS). Medicare Claims Processing Manual. Chapter 13: Radiology services and other diagnostic procedures. [CMS Web site]. 03/06/08. Available at: http://www.cms.hhs.gov/manuals/downloads/clm104c13.pdf. Accessed 01/26/2010.

Company Benefit Contracts.

Highmark Medicare Services. Local Coverage Determination (LCD).L27515: Radiation therapy services. [Highmark Medicare Services Web site]. Original: 07/11/08. (Revised: 01/14/10). Available at:
https://www.highmarkmedicareservices.com/policy/mac-ab/l27515-r8.html
Accessed January 14, 2010.




Coding

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.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

77417


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD-10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD-10 Diagnosis Code Number(s)

N/A


HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References


Policy History

Effective 10/05/2017 this policy has been updated to the new policy template
format.
Version Effective Date: 01/01/2016
Version Issued Date: 02/05/2016
Version Reissued Date: N/A

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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.