Q&A: Billing therapeutic radiology treatment planning

Q: I'm looking for clarification on how to bill for CPT code 77263 (therapeutic radiology treatment planning; complex). Can it be billed with the initial consultulation or should it be billed separately and before the simulation occurs?

A: Pages 75-77 of the American College of Radiation Oncology Coding and Billing Guide provides clarification for billing CPT code 77263. It is important to note this code is billable once per course of therapy, as the clinical treatment plan is a professional-only service. It is not appropriate to report an additional clinical treatment plan for the boost portion of a course of treatment.

Additionally, Medicare requires a written treatment plan that has been approved by the physician with the associated date and time. It is also important to note that the documentation of the clinical treatment plan is considered a separately billable service from the E/M service; therefore, it must be separately documented (p. 78).

Editor's note: Randy Wiitala, director of revenue integrity for Navigant, answered this question. 

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate action.

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