CPT code 77418 is for delivering intensity-modulated radiation therapy (IMRT), a precise cancer treatment that targets tumors while sparing healthy tissue.
CPT code 77418 is used to describe the delivery of radiation treatment using Intensity-Modulated Radiation Therapy (IMRT). IMRT is an advanced type of radiation therapy used to treat cancer and other conditions. It allows for the radiation dose to conform more precisely to the three-dimensional shape of the tumor by controlling—or modulating—the intensity of the radiation beam in multiple small volumes. This precision helps to minimize the dose to surrounding normal tissues, potentially reducing side effects and improving treatment outcomes. This code is specifically used for billing purposes when healthcare providers deliver this sophisticated form of radiation therapy to patients.
For the CPT codes provided, here are the potential modifiers that could be applicable:
1. Modifier 26 (Professional Component): This modifier is used when the service provided is the professional component of a procedure that has both professional and technical components. It indicates that the provider is billing only for the professional services rendered, such as interpretation of the images.
2. Modifier TC (Technical Component): This modifier is used when billing for the technical component of a procedure. It indicates that the provider is billing only for the technical services, such as the use of equipment and supplies.
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 may be necessary if multiple procedures are performed that are not typically reported together.
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 or procedure 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.
8. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): This modifier is used when a clinical diagnostic laboratory test is repeated on the same day to obtain subsequent test results.
These modifiers are used to provide additional information about the services rendered and ensure accurate billing and reimbursement. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 77418 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors.
The Medicare Physician Fee Schedule (MPFS) provides the national payment rates for services, including those associated with CPT code 77418.
However, the actual reimbursement can differ depending on the region, as Medicare Administrative Contractors (MACs) have the authority to adjust payment rates based on local considerations and policies.
Healthcare providers should consult the MPFS and their respective MAC for the most accurate and up-to-date reimbursement information for CPT code 77418.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including CPT code 77418. Schedule a demo today to see how RevFind can help you maximize reimbursements and streamline your financial operations.
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