CMS recognizes separate payment for physician work associated with superficial radiation treatment delivery

February 25, 2019
Medicare Web

CMS released Transmittal 4246 on February 22, revising language in Chapter 13 of the Medicare Claims Processing Manual regarding the billing of E/M codes on the same date of service as superficial radiation treatment delivery.

CPT codes for radiation treatment delivery recognize technical-only services and contain no physician work. Per the CPT Manual, E/M codes must be reported with these codes to identify any physician work associated with these services. However, Medicare contractors were previously instructed not to make separate payments for E/M services reported for the management of established patients undergoing superficial radiation treatment.

Per Transmittal 4246, effective for Medicare claims submitted on or after January 1, E/M level 1 through 3 codes used to report the physician work associated with radiation therapy planning, radiation treatment device construction, and radiation treatment management, may be billed on the same date of service as superficial radiation treatment delivery.

Specifically, the following E/M codes for office or other outpatient visits may be billed on the same date of service as CPT code 77401 (radiation treatment delivery, superficial or ortho voltage, per day):

  • 99211, office or other outpatient visit for the E/M of an established patient, that may not require the presence of a physician or other qualified health care professional; usually the presenting problem is minimal
  • 99212, office or other outpatient visit for the E/M of an established patient, requiring at least two of three components: A problem focused history, a problem focused exam, straightforward medical decision making
  • 99213, office or other outpatient visit for the E/M of an established patient, requiring at least two of three key components: An expanded problem focused history, an expanded problem focused exam, medical decision making of low complexity