In March 2016, CMS and the NCCI announced that they would remove the current edit prohibiting the reporting of CPT codes 77295 and 77300. The change will take effect today, July 1, 2016 (retroactive to January 1, 2016) and will be finalized in the July version of the NCCI Manual. Reporting requirements may vary by payer.
Providers (hospitals, physicians and freestanding cancer centers) should continue to track and capture the supported work of code 77300 during the 3D planning process. When the transmittal is released, providers will be able to submit those charges, along with the retroactive charges, for payment and in accordance with documentation guidelines and published Medically Unlikely Edits (MUEs).
Background: CMS originally implemented the prohibition of reporting these codes together (implemented January 1, 2016) because they believed the work of 77300 was integral to the work of 77295. Therefore, it should not be considered a separately reportable procedure. Opponents believed that this NCCI edit misinterpreted the work performed under these codes, resulting in unfair and significant payment cuts for radiation oncologists and facilities who were performing these critical procedures. This edit has since been removed (announced March 2016, effective July 1, 2016).
The Codes in Question:
77300: Basic radiation dosimetry calculation, central axis depth dose calculation, 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.
77295: 3-dimensional radiotherapy plans, including dose-volume histograms.
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