SRS SBRT

Coding Question: What are the appropriate planning codes that may be billed for SRS or SBRT treatments?

Coding Answer: For SRS and SBRT with forward planning, it is appropriate to bill CPT codes 77290 (simulation), 77295 (planning), and CPT either 77371/77372 (single fraction delivery) or 77373 (multifaction delivery). For SRS and SBRT with inverse planning, it is appropriate to bill CPT codes 77301 (both simulation and planning) and either 77371/77372 (single fraction delivery) or 77373 (multifaction delivery). Please see the chart below for a summary.

Coding Question: If a physician has two plans for two separate lesions, but treats these on alternate days that total more than five fractions, can SBRT codes be used?

Coding Answer: Instructions for CPT code 77373 (SBRT treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions) include the possibility of treating multiple sites of disease in one treatment course. Therefore, if the sum of the treatment days for all of the sites treated during a single course of therapy exceeds five; it is not appropriate to charge CPT code 77373 for SBRT delivery.

Coding Question: In a hospital-based setting using a linear accelerator-based modality, if a patient with three brain metastasis that require separate single-fraction treatment plans (related to clinical issues such as treatment time or integral dose), is it appropriate to charge the SRS treatment code (77372) and the weekly management code (77432) per treatment plan (i.e. charging 77372/77432 with each treatment delivery)? In addition, can each treatment plan (77295) be charged separately? Or should the hospital bill 77373 and the corresponding SBRT weekly management (77435) and just a single treatment plan (77295), regardless of the number of treatment plans generated and treated?

Coding Answer: If the intent is to treat three lesions separately but within the context of a single episode of care, then the appropriate codes would be 77373 for SBRT delivery, 77435 for SBRT physician management, and a single instance of 77295 for 3-D planning (or 77301 for IMRT planning). If these are discrete episodes of care with separate consultation notes, separate CT scans, separate clinical treatment plans, and separate end-of-treatment notes, then 77372, 77432, and 77295 may be charged for each episode of care.

Coding Question: With the new rotating multisource Cobalt 60 system, the number of shots for a treatment may exceed 10. Each shot will include a combination of various collimators. Would you follow the rule of one device per shot not to exceed 10, or would you have a different recommendation in determining the quantity of devices to be reported?

Coding Answer: For the billing of devices (CPT code 77334), it is recommended to bill for one device per collimator per episode of care. The maximum of 10 units applies to CPT code 77300 (basic radiation dosimetry calculation).

Coding Question: It is our understanding that there is a CCI edit for CPT codes 77371 and 77334. Was the relative value unit (RVU) for the multisource Cobalt 60 based stereotactic radiosurgery helmet included in the SRS treatment code, or should the helmet or collimator system be reported separately?

Coding Answer: There are no CCI edits between 77371 and 77334 so these codes can be reported together. Also, there are no practice expense (PE) RVUs associated with CPT code 77371. In the Medicare Physician Fee Schedule, 77371 has been assigned a payment status indicator of “C,” which stands for carrier priced. This means the price is set by local carriers; there are no national RVUs. There are, however, PE inputs for clinical staff time and medical supplies. It would, therefore, be appropriate to report the helmet and collimator system separately.

Coding Question: How would you code the devices for the IRIS Beam Aperture Caliper (IBAC) system of robotic linear accelerator-based stereotactic radiosurgery?

Coding Answer: There are 12 separate fixed collimators, and for coding purposes the IRIS aperture is considered the equivalent of a fixed collimator. With fixed collimators, although the number performed is frequently ≤4 for SBRT, sometimes a greater number is required. You would normally charge 1x CPT code 77334 for each aperture size or fixed collimator.

Coding Question: Is there a situation where CPT code 77290 would apply instead of 77280 for verification simulation prior to each SBRT treatment fraction? Since the SBRT is delivered with arc therapy, the providers would like to report CPT code 77290 for "daily" verification simulation.

Coding Answer: It may be appropriate to perform a verification simulation prior to the first treatment session to verify immobilization, linac clearance, etc. As such, the appropriate simulation is CPT code 77280. It is not appropriate, however, to bill a daily simulation for isocenter location, since image guidance is included in the SBRT delivery codes.

Disclaimer: The opinions referenced are those of members of the ASTRO Code Utilization and Application Subcommittee based on their coding experience and they are provided, without charge, as a service to the profession. They are based on the commonly used codes in radiation oncology, which are not all inclusive. Always check with your local insurance carriers, as policies vary by region. The final decision for coding for any procedure must be made by the physician, considering regulations of insurance carriers and any local, state or federal laws that apply to the physicians practice. ASTRO nor any of its officers, directors, agents, employees, committee members or other representatives shall have any liability for any claim, whether founded or unfounded, of any kind whatsoever, including but not limited to any claim for costs and legal fees, arising from the use of these opinions.  

All CPT code descriptors have been taken from Current Procedural Terminology (CPT®) 2015, American Medical Association. All Rights Reserved.

CPT is registered trademark of the American Medical Association.