Reminder: IMRT delivery codes

Blue Cross Blue Shield of Michigan continues to expand its claim editing process to further promote correct coding and payment accuracy. As part of our efforts, we want to remind you that delivery codes for intensity-modulated radiation therapy, or IMRT, that are billed within a 14-day period before or after the IMRT planning code shouldn’t be billed separately. 

CPT codes *77014, *77280, *77285, *77290, *77295, *77306 through *77321, *77331 and *77370 are considered as included in the payment for CPT code *77301 (IMRT planning) when performed as part of the development of the IMRT plan on the same or different dates of service for the same tumor. This is in alignment with guidelines from the American Medical Association, as well as the Centers for Medicare & Medicaid Service’s National Correct Coding Initiative Policy Manual.

Be sure to bill IMRT services according to the above guidelines. When the above-mentioned CPT codes are billed separately, they may be denied.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.