Billing policy and guidelines for intensity modulated radiation therapy

When billing for intensity modulated radiation therapy, or IMRT, the following guidelines should be followed, in accordance with a new Blue Cross Blue Shield of Michigan policy. This policy has been adopted to align billing requirements with industry and Centers for Medicare & Medicaid Services standards.

When an IMRT simulation is performed on the same tumor within 14 days before an IMRT plan, reimbursement of the simulation will be included in the reimbursement whether the simulation is reported on the same or different date of service. In addition, the IMRT policy addresses certain radiation therapy services that may be performed 14 days before, on, or as part of the development of the IMRT plan.

In accordance with the American Medical Association and CMS’ National Correct Coding Initiative Policy Manual, Blue Cross considers CPT codes *77014, *77280, *77285, *77290, *77295, *77306 through *77321, *77331 and *77370 as included in the payment for CPT code *77301 (IMRT planning) when performed in the development of the IMRT plan on the same or different dates of service for the same tumor. To report services for a different tumor on a different date of service, use the appropriate modifier to identify that it is separate, distinct and unrelated to the IMRT plan. 

IMRT simulation services billed separately and not billed according to the above guidelines will be denied.