CPT code 77373 is for stereotactic body radiation therapy (SBRT) delivery, a precise radiation treatment targeting tumors in the body.
CPT code 77373 is used to describe the delivery of stereotactic body radiation therapy (SBRT). This code is specifically for the treatment phase where high doses of radiation are precisely delivered to a targeted area within the body, typically for treating tumors in areas such as the lungs, liver, or spine. SBRT is known for its precision and ability to minimize damage to surrounding healthy tissues, making it a preferred option for certain types of cancer treatments. This code is utilized by healthcare providers to document and bill for the technical and professional services involved in administering this advanced form of radiation therapy.
1. Modifier 26 - Professional Component
- This modifier is used when the service provided is the professional component of the procedure, typically involving the interpretation of results or the supervision of the procedure. It is applicable when the technical component is billed separately by another entity.
2. Modifier TC - Technical Component
- This modifier is used when billing for the technical component of the service, which includes the use of equipment, supplies, and technical staff. It is applicable when the professional component is billed separately by another entity.
3. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is applicable when procedures are not normally reported together but are appropriate under the circumstances.
4. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
5. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room
- This modifier is used when a related procedure is performed during the postoperative period of the initial procedure, requiring a return to the operating room.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
- This modifier is used for repeat laboratory tests performed on the same day to obtain subsequent (multiple) test results.
These modifiers help ensure accurate billing and reimbursement by providing additional context to the services rendered. It is crucial for healthcare providers to apply the appropriate modifiers to avoid claim denials and ensure compliance with payer requirements.
CPT code 77373 is indeed reimbursed by Medicare, but the reimbursement specifics can vary based on several factors.
The Medicare Physician Fee Schedule (MPFS) provides a standardized payment structure for services covered under Medicare Part B, including those represented by CPT code 77373.
However, the actual reimbursement rate for this code can differ depending on geographic location and other considerations managed by the Medicare Administrative Contractor (MAC) responsible for the region.
Each MAC may have its own guidelines and fee schedules that influence the final reimbursement amount for CPT code 77373.
Therefore, healthcare providers should consult their local MAC for precise reimbursement details and ensure compliance with any specific documentation or billing requirements.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including CPT code 77373, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
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