CPT CODES

CPT Code 77385

CPT code 77385 is for delivering radiation therapy using a simple intensity-modulated radiation treatment (IMRT) plan.

Table of Contents
What is CPT Code 77385
Does CPT 77385 Need a Modifier?
CPT Code 77385 Medicare Reimbursement
Are You Being Underpaid for 77385 CPT Code?
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What is CPT Code 77385

CPT code 77385 is used to describe the delivery of intensity-modulated radiation therapy (IMRT) for cancer treatment. This code specifically refers to the use of IMRT in a simple treatment delivery setting. IMRT is an advanced type of radiation therapy that allows for the radiation dose to conform more precisely to the three-dimensional shape of the tumor by modulating—or controlling—the intensity of the radiation beam in multiple small volumes. The "simple" designation typically indicates that the treatment involves a straightforward setup and delivery process, often with fewer treatment fields or less complex planning compared to more intricate cases. This code is crucial for healthcare providers to accurately bill for the specific type of radiation therapy service provided to patients.

Does CPT 77385 Need a Modifier?

1. Modifier 26 - Professional Component
- Used when the professional component of the service is provided separately from the technical component. This is applicable when a physician provides the interpretation and report of the radiation therapy delivery.

2. Modifier TC - Technical Component
- Applied when only the technical component of the service is provided. This is relevant when the facility provides the equipment, supplies, and technical staff for the radiation therapy delivery.

3. Modifier 59 - Distinct Procedural Service
- Utilized to indicate that a procedure or service was distinct or independent from other services performed on the same day. This can be necessary if multiple procedures are performed that are not typically reported together.

4. Modifier 76 - Repeat Procedure by Same Physician
- Used when the same procedure is repeated by the same physician on the same day. This can occur in cases where multiple sessions of radiation therapy are required.

5. Modifier 77 - Repeat Procedure by Another Physician
- Applied when the same procedure is repeated by a different physician on the same day. This might be necessary in collaborative treatment settings.

CPT Code 77385 Medicare Reimbursement

The CPT code 77385 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). However, the reimbursement specifics, such as the rate and any applicable conditions, can vary based on the region and the policies set by the respective Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and determining coverage specifics within their jurisdiction, so it's important for healthcare providers to consult their local MAC for detailed information regarding reimbursement for CPT code 77385.

Are You Being Underpaid for 77385 CPT Code?

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