Carriers must pay for a physician’s weekly treatment management services under code 77427. Billing entities must indicate on each claim the number of fractions for which payment is sought.
A weekly unit of treatment management is equal to five fractions or treatment sessions. A week for the purpose of making payments under these codes is comprised of five fractions regardless of the actual time period in which the services are furnished. It is not necessary that the radiation therapist personally examine the patient during each fraction for the weekly treatment management code to be payable. Multiple fractions representing two or more treatment sessions furnished on the same day may be counted as long as there has been a distinct break in therapy sessions, and the fractions are of the character usually furnished on different days. If, at the final billing of the treatment course, there are three or four fractions beyond a multiple of five, those three or four fractions are paid for as a week. If there are one or two fractions beyond a multiple of five, payment for these services is considered as having been made through prior payments.
EXAMPLE: 18 fractions = 4 weekly services
62 fractions = 12 weekly services
8 fractions = 2 weekly services
6 fractions = 1 weekly service
If billings have occurred which indicate that the treatment course has ended (and, therefore, the number of residual fractions has been determined), but treatments resume, adjust carrier payments for the additional services consistent with the above policy.
EXAMPLE: 8 fractions = payment for 2 weeks
2 additional fractions are furnished by the same physician. No additional Medicare payment is made for the 2 additional fractions.
A. SNF Treatment Management Delivery Services
A SNF may not bill weekly treatment management services for its outpatients (codes 77419, 77420, 77425, 77430, and 77431). Instead, the SNF should bill for radiation treatment delivery (codes 77401 – 77404, 77406 – 77409, 77411 – 77414, and 77416).
Also, SNFs bill for therapeutic radiology port film (code 77417), which was previously a part of the weekly services. They enter the number of services in the units field.