New Code Bundling Rules for Radiation Oncology Effective July 1

Effective July 1, 2021, there will be new code bundling rules for Radiation Oncology that will require providers to ensure that they are using the appropriate codes. 

In line with the American Society for Radiation Oncology (ASTRO), CPT® 77301, which represents the Intensity Modulated Radiation Therapy (IMRT), also includes other related radiation therapy services performed as part of the development of the IMRT plan.  

According to the Centers for Medicare and Medicaid Services (CMS), CPT® 77280, 77285, 77290, 77295, 77306, 77307, 77321, 77331 and 77370 are considered inclusive to code 77301. These codes may not be billed separately if they are performed as part of developing an IMRT treatment plan, whether they are billed on the same or different date of service (CMS Manual, chapter 4, §§ 200.3.1 and 200.3.2).  

In addition, CPT® codes 77280, 77285, 77290, 77295, 77306, 77307, 77321, 77331 and 77370 are not separately reimbursable when performed 30 days prior/after and the day of CPT® code 77301 by the same group practice for the same member. Modifier 59 is appropriate to represent a distinct procedural service for a different tumor on a different date of service, and unrelated to the IMRT plan. 

These changes apply to the following lines of business: Administrative Services Only (ASO groups), fully insured membership, Blue Card IPP Host and State Health Plan (SHP). 

More information about the IMRT policy notice can be found on the Medical Policy Updates page.