MEDICAL RADIATION PHYSICS, DOSIMETRY, TREATMENT DEVICES AND SPECIAL SERVICES
77295 3-dimensional radiotherapy plan, including dose-volume histograms
77300 Basic radiation dosimetry calculation, central axis depth dose, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician
77301 Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications
77306 Teletherapy isodose plan, simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s)
77307 complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)
77316 Brachytherapy isodose plan; simple (calculation(s) made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)
77317 intermediate (calculation(s) made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channel(s), includes basic dosimetry calculation(s)
77318 complex calculation(s) made from over 10 sources, or remote afterloading brachytherapy, over 12 channel(s), includes basic
dosimetry calculation(s)
77321 Special teletherapy port plan, particles, hemi-body, total body
77331 Special dosimetry (eg, TLD, microdosimetry) (specify), only when prescribed by the treating physician
77332 Treatment devices, design and construction; simple (simple block, simple bolus)
77333 intermediate (multiple blocks, stents, bite blocks, special bolus)
77334 complex (irregular blocks, special shields, compensators, wedges, molds or casts)
77336 Continuing medical radiation physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy (Reimbursement is for the global fee)
77338 Multi-leaf collimator MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan
(Do not report 77338 more than once per IMRT plan)
STEREOTACTIC RADIATION TREATMENT DELIVERY
77371 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source Cobalt 60 based
77372 linear accelerator based
77373 Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions
OTHER PROCEDURES
77399 Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services
