55875 55876 55876 Description Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or wout cytosocopy 55920 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter) prostate, single or multiple 49411 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter) prostate, single or multiple 49412 Description Source Placement of needles, catheters, or other device(s) into the head and/or neck region (percutaneous, transoral, or transnasal) for subsequent interstitial radioelement application Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-abdominal, intra-pelvic (except prostate), and/or retroperitoneum, single or multiple ( ) py Guidance (Eg, Fiducial Markers, Dosimeter), Open, Intra- Abdominal, Intrapelvic, And/Or Retroperitoneum, Including Image Guidance, If Performed, Single Or Multiple (List Separately In Addition To For Primary Procedure) 55920 Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or out cytosocopy 57156 Insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy 76950 Ultrasound Localization of Radiation Therapy Fields 0197T Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (eg, 3D positional tracking, gating, 3D surface tracking), each fraction of treatment 77014 CT guidance for placement of radiation therapy fields 76950 Ultrasound Localization of Radiation Therapy Fields 77014 CT guidance for placement of radiation therapy fields 77421 stereoscopic x-ray guidance for localization of target volume 77014 CT guidance for placement of radiation therapy fields 0197T Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (eg, 3D positional tracking, gating, 3D surface tracking), each fraction of treatment 77261 Therapeutic Radiology treatment planning;simple 77336 Continuing medical physics consultation 77262 Therapeutic Radiology treatment planning; intermediate 77261 Therapeutic Radiology treatment planning;simple 77262 Therapeutic Radiology treatment planning; intermediate 77336 Continuing medical physics consultation 77263 Therapeutic Radiology treatment planning; complex 77261 Therapeutic Radiology treatment planning;simple 77263 Therapeutic Radiology treatment planning; complex 77262 Therapeutic Radiology treatment planning; intermediate 77263 Therapeutic Radiology treatment planning; complex 77336 Continuing medical physics consultation 77280 Therapeutic Radiology Simulation; simple 77336 Continuing medical physics consultation 77285 Therapeutic Radiology Simulation; intermediate 77280 Therapeutic Radiology Simulation; simple 77285 Therapeutic Radiology Simulation; intermediate 77336 Continuing medical physics consultation 77290 Therapeutic Radiology Simulation; complex 77280 Therapeutic Radiology Simulation; simple 77290 Therapeutic Radiology Simulation; complex 77285 Therapeutic Radiology Simulation; intermediate 77290 Therapeutic Radiology Simulation; complex 77336 Continuing medical physics consultation 77295 Therapeutic Radiology Simulation 3-Dimensional 77014 CT guidance for placement of radiation therapy fields 77295 Therapeutic Radiology Simulation 3-Dimensional 77280 Therapeutic Radiology Simulation; simple 77295 Therapeutic Radiology Simulation 3-Dimensional 77285 Therapeutic Radiology Simulation; intermediate 77295 Therapeutic Radiology Simulation 3-Dimensional 77290 Therapeutic Radiology Simulation; complex 77295 Therapeutic Radiology Simulation 3-Dimensional 77305 Teletherapy isodose plan simple Updated 3/19/2012 1
Description Description Source 77295 Therapeutic Radiology Simulation 3-Dimensional 77310 Teletherapy isodose plan; intermediate 77295 Therapeutic Radiology Simulation 3-Dimensional 77315 Teletherapy Isodose plan; complex 77295 Therapeutic Radiology Simulation 3-Dimensional 77336 Continuing medical physics consultation 77300 Basic Radiation Dosimetry 77331 Special radiation dosimetry 77301 IMRT Planning 76950 Ultrasound Localization of Radiation Therapy Fields 77301 IMRT Planning 77014 CT guidance for placement of radiation therapy fields 77301 IMRT Planning 77261 Therapeutic Radiology treatment planning;simple 77301 IMRT Planning 77262 Therapeutic Radiology treatment planning; intermediate 77301 IMRT Planning 77263 Therapeutic Radiology treatment planning; complex 77301 IMRT Planning 77280 Therapeutic Radiology Simulation; simple 77301 IMRT Planning 77285 Therapeutic Radiology Simulation; intermediate 77301 IMRT Planning 77290 Therapeutic Radiology Simulation; complex 77301 IMRT Planning 77295 Therapeutic Radiology Simulation 3-Dimensional 77301 IMRT Planning 77305 Teletherapy isodose plan simple 77301 IMRT Planning 77310 Teletherapy isodose plan; intermediate 77301 IMRT Planning 77315 Teletherapy Isodose plan; complex 77301 IMRT Planning 77321 Special Teletherapy port plan, particles, hemibody, total body 77301 IMRT Planning 77326 Brachytherapy Isodose Plan; simple 77301 IMRT Planning 77327 Brachytherapy Isodose Plan; intermediate 77301 IMRT Planning 77328 Brachytherapy Isodose Plan; complex 77301 IMRT Planning 77331 Special radiation dosimetry 77301 IMRT Planning 77332 Treatment Devices; simple 77301 IMRT Planning 77333 Treatment Devices; intermediate 77301 IMRT Planning 77334 Treatment Devices; complex 77301 IMRT Planning 77336 Continuing medical physics consultation 77301 IMRT Planning 77370 Special medical physics consultation 77301 IMRT Planning 77401 Radiation treatment delivery; superficial and/or ortho voltage 77301 IMRT Planning 77402 77301 IMRT Planning 77403 19 MeV Updated 3/19/2012 2
Description 77301 IMRT Planning 77404 77301 IMRT Planning 77406 77301 IMRT Planning 77407 77301 IMRT Planning 77408 Description Source 10 MeV blocks; up blocks; 6-10 MeV 77301 IMRT Planning 77409 blocks; 11-19 MeV 77301 IMRT Planning 77411 77301 IMRT Planning 77412 77301 IMRT Planning 77413 77301 IMRT Planning 77414 77301 IMRT Planning 77416 blocks; 20 MeV or greater rotational beam, compensators, electron beam; up greater 77301 IMRT Planning 77417 Therapeutic Radiology Port Films 77301 IMRT Planning 77421 stereoscopic x-ray guidance for localization of target volume 77301 IMRT Planning 77422 Neutron beam tx, simple 77301 IMRT Planning 77423 Neutron beam tx, complex 77301 IMRT Planning 77427 Radiation treatment management, five treatments 77301 IMRT Planning 77431 77301 IMRT Planning 77432 therapy consisting of 1-2 fractions Stereotactic radiation treatment management cerebral lesion(s) complete course of treatment consisting of 1 session 77301 IMRT Planning 77435 77301 IMRT Planning 77470 Stereotactic body radiation treatment management per treatment course; 1 or more lesions, including image guidance entire course not to exceed 5 fractions Special Treatment Procedure (eg. Total body radiation, hemibody radiation, per oral endocavity or intraoperative cone irradiation) 77301 IMRT Planning 77520 Proton treatment delivery, simple w/o compensation Updated 3/19/2012 3
Description Description Source 77301 IMRT Planning 77522 Proton treatment delivery, simple w/ compensation 77301 IMRT Planning 77523 Proton treatment delivery, intermediate 77301 IMRT Planning 77525 Proton treatment delivery, complex 77305 Teletherapy isodose plan simple 77014 CT guidance for placement of radiation therapy fields 77305 Teletherapy isodose plan simple 77336 Continuing medical physics consultation 77310 Teletherapy isodose plan; intermediate 77014 CT guidance for placement of radiation therapy fields 77310 Teletherapy isodose plan; intermediate 77305 Teletherapy isodose plan simple 77310 Teletherapy isodose plan; intermediate 77336 Continuing medical physics consultation 77315 Teletherapy Isodose plan; complex 77014 CT guidance for placement of radiation therapy fields 77315 Teletherapy Isodose plan; complex 77305 Teletherapy isodose plan simple 77315 Teletherapy Isodose plan; complex 77310 Teletherapy isodose plan; intermediate 77315 Teletherapy Isodose plan; complex 77336 Continuing medical physics consultation 77321 Special Teletherapy port plan, particles, hemibody, total body 77305 Teletherapy isodose plan simple 77321 Special Teletherapy port plan, particles, hemibody, total body 77310 Teletherapy isodose plan; intermediate 77321 Special Teletherapy port plan, particles, hemibody, total body 77315 Teletherapy Isodose plan; complex 77321 Special Teletherapy port plan, particles, hemibody, total body 77336 Continuing medical physics consultation 77326 Brachytherapy Isodose Plan; simple 77336 Continuing medical physics consultation 77327 Brachytherapy Isodose Plan; intermediate 77326 Brachytherapy Isodose Plan; simple 77327 Brachytherapy Isodose Plan; intermediate 77336 Continuing medical physics consultation 77328 Brachytherapy Isodose Plan; complex 77326 Brachytherapy Isodose Plan; simple 77328 Brachytherapy Isodose Plan; complex 77327 Brachytherapy Isodose Plan; intermediate 77328 Brachytherapy Isodose Plan; complex 77336 Continuing medical physics consultation 77332 Treatment Devices; simple 77336 Continuing medical physics consultation 77333 Treatment Devices; intermediate 77332 Treatment Devices; simple 77333 Treatment Devices; intermediate 77336 Continuing medical physics consultation 77334 Treatment Devices; complex 77332 Treatment Devices; simple 77334 Treatment Devices; complex 77333 Treatment Devices; intermediate 77334 Treatment Devices; complex 77336 Continuing medical physics consultation 77336 Continuing medical physics consultation 77370 Special medical physics consultation 77338 Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan 0073T Compensator-based IMRT delivery Updated 3/19/2012 4
77338 77338 77338 Description Description Source Multi-leaf Collimator (MLC) device(s) for intensity modulated radiation theratpy (IMRT), design and construction per IMRT plan 77332 Treatment Devices; simple Multi-leaf Collimator (MLC) device(s) for intensity modulated radiation theratpy (IMRT), design and construction per IMRT plan 77333 Treatment Devices; intermediate Multi-leaf Collimator (MLC) device(s) for intensity modulated radiation theratpy (IMRT), design and construction per IMRT plan 77334 Treatment Devices; complex Cobalt 60 based 76950 Ultrasound Localization of Radiation Therapy Fields Cobalt 60 based 77014 CT guidance for placement of radiation therapy fields Cobalt 60 based 77305 Teletherapy isodose plan simple Cobalt 60 based 77310 Teletherapy isodose plan; intermediate Cobalt 60 based 77315 Teletherapy Isodose plan; complex Cobalt 60 based 77326 Brachytherapy Isodose Plan; simple Cobalt 60 based 77327 Brachytherapy Isodose Plan; intermediate Cobalt 60 based 77328 Brachytherapy Isodose Plan; complex Cobalt 60 based 77332 Treatment Devices; simple Cobalt 60 based 77333 Treatment Devices; intermediate Cobalt 60 based of treatment of cerebral lesion(s) 1 session, linac based Cobalt 60 based 77401 Radiation treatment delivery; superficial and/or ortho voltage Cobalt 60 based 77402 Updated 3/19/2012 5
Description Cobalt 60 based 77403 Cobalt 60 based 77404 Cobalt 60 based 77406 Cobalt 60 based 77407 Cobalt 60 based 77408 Cobalt 60 based 77409 Description Source 19 MeV 10 MeV blocks; up blocks; 6-10 MeV blocks; 11-19 MeV Cobalt 60 based 77411 blocks; 20 MeV or greater Cobalt 60 based 77412 Cobalt 60 based 77413 Cobalt 60 based 77414 Cobalt 60 based 77416 rotational beam, compensators, electron beam; up greater Cobalt 60 based 77421 stereoscopic x-ray guidance for localization of target volume Cobalt 60 based 77422 Neutron beam tx, simple Cobalt 60 based 77423 Neutron beam tx, complex Cobalt 60 based 77427 Radiation treatment management, five treatments Cobalt 60 based 77431 Cobalt 60 based 77435 Cobalt 60 based 77470 therapy consisting of 1-2 fractions Stereotactic body radiation treatment management per treatment course; 1 or more lesions, including image guidance entire course not to exceed 5 fractions Special Treatment Procedure (eg. Total body radiation, hemibody radiation, per oral endocavity or intraoperative cone irradiation) Updated 3/19/2012 6
Description Cobalt 60 based Description g g p Source motion during delivery of radiation therapy (eg, 3D positional tracking, gating, 3D surface tracking), each fraction of 0197T treatment Cobalt 60 based G0251 Stereotactic, 2-5 Treatments Cobalt 60 based G0339 Robotic stereotactic surgery 1 session Cobalt 60 based G0340 Robotic stereotactic radiosugery 2 through 5 sessions of treatment of cerebral lesion(s) 1 session, linac based 76950 Ultrasound Localization of Radiation Therapy Fields of treatment of cerebral lesion(s) 1 session, linac based 77014 CT guidance for placement of radiation therapy fields of treatment of cerebral lesion(s) 1 session, linac based 77305 Teletherapy isodose plan simple of treatment of cerebral lesion(s) 1 session, linac based 77310 Teletherapy isodose plan; intermediate of treatment of cerebral lesion(s) 1 session, linac based 77315 Teletherapy Isodose plan; complex of treatment of cerebral lesion(s) 1 session, linac based 77326 Brachytherapy Isodose Plan; simple of treatment of cerebral lesion(s) 1 session, linac based 77327 Brachytherapy Isodose Plan; intermediate of treatment of cerebral lesion(s) 1 session, linac based 77328 Brachytherapy Isodose Plan; complex of treatment of cerebral lesion(s) 1 session, linac based 77332 Treatment Devices; simple of treatment of cerebral lesion(s) 1 session, linac based 77333 Treatment Devices; intermediate of treatment of cerebral lesion(s) 1 session, linac based 77401 Radiation treatment delivery; superficial and/or ortho voltage of treatment of cerebral lesion(s) 1 session, linac based 77403 of treatment of cerebral lesion(s) 1 session, linac based 77404 of treatment of cerebral lesion(s) 1 session, linac based 77406 of treatment of cerebral lesion(s) 1 session, linac based 77407 19 MeV 10 MeV blocks; up Updated 3/19/2012 7
Description of treatment of cerebral lesion(s) 1 session, linac based 77408 of treatment of cerebral lesion(s) 1 session, linac based 77409 of treatment of cerebral lesion(s) 1 session, linac based 77411 of treatment of cerebral lesion(s) 1 session, linac based 77413 of treatment of cerebral lesion(s) 1 session, linac based 77414 of treatment of cerebral lesion(s) 1 session, linac based 77416 Description Source blocks; 6-10 MeV blocks; 11-19 MeV blocks; 20 MeV or greater y; p y; p y; p greater of treatment of cerebral lesion(s) 1 session, linac based 77421 stereoscopic x-ray guidance for localization of target volume of treatment of cerebral lesion(s) 1 session, linac based 77422 Neutron beam tx, simple of treatment of cerebral lesion(s) 1 session, linac based 77423 Neutron beam tx, complex of treatment of cerebral lesion(s) 1 session, linac based 77427 Radiation treatment management, five treatments of treatment of cerebral lesion(s) 1 session, linac based 77431 of treatment of cerebral lesion(s) 1 session, linac based 77435 of treatment of cerebral lesion(s) 1 session, linac based 77470 of treatment of cerebral lesion(s) 1 session, linac based 0197T therapy consisting of 1-2 fractions Stereotactic body radiation treatment management per treatment course; 1 or more lesions, including image guidance entire course not to exceed 5 fractions Special Treatment Procedure (eg. Total body radiation, hemibody radiation, per oral endocavity or intraoperative cone irradiation) g g p motion during delivery of radiation therapy (eg, 3D positional tracking, gating, 3D surface tracking), each fraction of treatment of treatment of cerebral lesion(s) 1 session, linac based G0251 Stereotactic, 2-5 Treatments of treatment of cerebral lesion(s) 1 session, linac based G0339 Robotic stereotactic surgery 1 session of treatment of cerebral lesion(s) 1 session, linac based G0340 Robotic stereotactic radiosugery 2 through 5 sessions fractions 76950 Ultrasound Localization of Radiation Therapy Fields fractions 77014 CT guidance for placement of radiation therapy fields Updated 3/19/2012 8
Description Description Source fractions 77305 Teletherapy isodose plan simple fractions 77310 Teletherapy isodose plan; intermediate fractions 77315 Teletherapy Isodose plan; complex fractions 77326 Brachytherapy Isodose Plan; simple fractions 77327 Brachytherapy Isodose Plan; intermediate fractions 77328 Brachytherapy Isodose Plan; complex fractions 77332 Treatment Devices; simple fractions 77333 Treatment Devices; intermediate fractions fractions Cobalt 60 based of treatment of cerebral lesion(s) 1 session, linac based fractions 77401 Radiation treatment delivery; superficial and/or ortho voltage fractions 77402 fractions 77403 fractions 77404 fractions 77406 fractions 77408 fractions 77409 fractions 77411 fractions 77412 19 MeV 10 MeV blocks; 6-10 MeV blocks; 11-19 MeV blocks; 20 MeV or greater rotational beam, compensators, electron beam; up Updated 3/19/2012 9
Description fractions 77413 fractions 77414 fractions 77416 y; Description p Source y; p y; p greater fractions 77421 stereoscopic x-ray guidance for localization of target volume fractions 77422 Neutron beam tx, simple fractions 77423 Neutron beam tx, complex fractions 77427 Radiation treatment management, five treatments fractions 77431 fractions 77432 fractions 77470 fractions 0197T therapy consisting of 1-2 fractions Stereotactic radiation treatment management cerebral lesion(s) complete course of treatment consisting of 1 session Special Treatment Procedure (eg. Total body radiation, hemibody radiation, per oral endocavity or intraoperative cone irradiation) g g p motion during delivery of radiation therapy (eg, 3D positional tracking, gating, 3D surface tracking), each fraction of treatment fractions G0251 Stereotactic, 2-5 Treatments fractions G0339 Robotic stereotactic surgery 1 session fractions G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77401 Radiation treatment delivery; superficial and/or ortho voltage 77422 Neutron beam tx, simple 77401 Radiation treatment delivery; superficial and/or ortho voltage 0073T Compensator-based IMRT delivery CPT/AMA 77402 77402 77402 77401 Radiation treatment delivery; superficial and/or ortho voltage 77422 Neutron beam tx, simple 0073T Compensator-based IMRT delivery CPT/AMA Updated 3/19/2012 10
77403 77403 77403 77403 77403 77404 77404 77404 77404 77404 77406 77406 77406 77406 77406 77406 77407 77407 77407 Description Description Source port or parallel opposed ports, simple blocks or no blocks; 11-19 MeV 0073T Compensator-based IMRT delivery CPT/AMA 19 MeV 77401 Radiation treatment delivery; superficial and/or ortho voltage 19 MeV 77402 19 MeV 77422 Neutron beam tx, simple 19 MeV 77520 Proton treatment delivery, simple w/o compensation port or parallel opposed ports, simple blocks or no blocks; 6-10 MeV 0073T Compensator-based IMRT delivery CPT/AMA 10 MeV 77401 Radiation treatment delivery; superficial and/or ortho voltage 10 MeV 77402 10 MeV 77403 19 MeV 10 MeV 77422 Neutron beam tx, simple port or parallel opposed ports, simple blocks or no blocks; 20 0073T Compensator-based IMRT delivery CPT/AMA 77401 Radiation treatment delivery; superficial and/or ortho voltage 77402 77403 77404 19 MeV 10 MeV 77422 Neutron beam tx, simple blocks; up 0073T Compensator-based IMRT delivery CPT/AMA blocks; up 77401 Radiation treatment delivery; superficial and/or ortho voltage blocks; up 77402 Updated 3/19/2012 11
77407 77407 77407 77407 77407 77408 77408 77408 77408 77408 77408 77408 77408 77409 77409 77409 77409 77409 77409 Description blocks; up 77403 blocks; up 77404 blocks; up 77406 Description Source 19 MeV 10 MeV blocks; up 77422 Neutron beam tx, simple blocks; up 77520 Proton treatment delivery, simple w/o compensation blocks; 6-10 MeV 0073T Compensator-based IMRT delivery CPT/AMA blocks; 6-10 MeV 77401 Radiation treatment delivery; superficial and/or ortho voltage blocks; 6-10 MeV 77402 blocks; 6-10 MeV 77403 blocks; 6-10 MeV 77404 blocks; 6-10 MeV 77406 blocks; 6-10 MeV 77407 19 MeV 10 MeV blocks; up blocks; 6-10 MeV 77422 Neutron beam tx, simple blocks; 11-19 MeV 0073T Compensator-based IMRT delivery CPT/AMA blocks; 11-19 MeV 77401 Radiation treatment delivery; superficial and/or ortho voltage blocks; 11-19 MeV 77402 blocks; 11-19 MeV 77403 blocks; 11-19 MeV 77404 blocks; 11-19 MeV 77406 19 MeV 10 MeV Updated 3/19/2012 12
77409 77409 77409 77411 77411 Description blocks; 11-19 MeV 77407 blocks; 11-19 MeV 77408 Description Source blocks; up blocks; 6-10 MeV blocks; 11-19 MeV 77422 Neutron beam tx, simple blocks; 20 MeV or greater 0073T Compensator-based IMRT delivery CPT/AMA blocks; 20 MeV or greater 77401 Radiation treatment delivery; superficial and/or ortho voltage 77411 blocks; 20 MeV or greater 77402 77411 77411 blocks; 20 MeV or greater 77403 blocks; 20 MeV or greater 77404 19 MeV 10 MeV 77411 blocks; 20 MeV or greater 77406 77411 blocks; 20 MeV or greater 77407 blocks; up 77411 blocks; 20 MeV or greater 77408 blocks; 6-10 MeV 77411 blocks; 20 MeV or greater 77409 blocks; 11-19 MeV 77411 77412 77412 blocks; 20 MeV or greater 77422 Neutron beam tx, simple rotational beam, compensators, electron beam; up 0073T Compensator-based IMRT delivery CPT/AMA rotational beam, compensators, electron beam; up 77401 Radiation treatment delivery; superficial and/or ortho voltage 77412 rotational beam, compensators, electron beam; up 77402 Updated 3/19/2012 13
Description Description Source 77412 77412 rotational beam, compensators, electron beam; up 77403 rotational beam, compensators, electron beam; up 77404 19 MeV 10 MeV 77412 rotational beam, compensators, electron beam; up 77406 77412 rotational beam, compensators, electron beam; up 77407 blocks; up 77412 rotational beam, compensators, electron beam; up 77408 blocks; 6-10 MeV 77412 rotational beam, compensators, electron beam; up 77409 blocks; 11-19 MeV 77412 rotational beam, compensators, electron beam; up 77411 blocks; 20 MeV or greater 77412 77412 77413 77413 77413 77413 77413 77413 rotational beam, compensators, electron beam; up 77422 Neutron beam tx, simple rotational beam, compensators, electron beam; up 77423 Neutron beam tx, complex 0073T Compensator-based IMRT delivery CPT/AMA 77401 Radiation treatment delivery; superficial and/or ortho voltage 77402 77403 77404 77406 19 MeV 10 MeV Updated 3/19/2012 14
77413 77413 77413 77413 77413 77413 77413 77414 77414 77414 77414 77414 77414 77414 77414 Description 77407 77408 77409 77411 77412 Description Source blocks; up blocks; 6-10 MeV blocks; 11-19 MeV blocks; 20 MeV or greater rotational beam, compensators, electron beam; up 77422 Neutron beam tx, simple 77423 Neutron beam tx, complex 0073T Compensator-based IMRT delivery CPT/AMA 77401 Radiation treatment delivery; superficial and/or ortho voltage 77402 77403 77404 77406 77407 77408 19 MeV 10 MeV blocks; up blocks; 6-10 MeV Updated 3/19/2012 15
77414 77414 77414 77414 77414 77416 77416 77416 77416 77416 77416 77416 77416 77416 77416 Description 77411 77412 77413 Description Source blocks; 20 MeV or greater rotational beam, compensators, electron beam; up 77422 Neutron beam tx, simple 77423 Neutron beam tx, complex greater 0073T Compensator-based IMRT delivery CPT/AMA greater 77401 Radiation treatment delivery; superficial and/or ortho voltage greater 77402 greater 77403 greater 77404 greater 77406 greater 77407 greater 77408 greater 77409 greater 77411 19 MeV 10 MeV blocks; up blocks; 6-10 MeV blocks; 11-19 MeV blocks; 20 MeV or greater Updated 3/19/2012 16
77416 77416 77416 77416 77416 Description greater 77412 greater 77413 greater 77414 Description Source rotational beam, compensators, electron beam; up greater 77422 Neutron beam tx, simple greater 77423 Neutron beam tx, complex IMRT Treatment Delivery; single or multiple fields/arcs, via dynamic MLC, per treatment session 0073T Compensator-based IMRT delivery CPT/AMA dynamic MLC, per treatment session 76965 Ultrasound guidance for interstitial radioelement application dynamic MLC, per treatment session 77261 Therapeutic Radiology treatment planning;simple dynamic MLC, per treatment session 77262 Therapeutic Radiology treatment planning; intermediate dynamic MLC, per treatment session 77263 Therapeutic Radiology treatment planning; complex dynamic MLC, per treatment session 77305 Teletherapy isodose plan simple dynamic MLC, per treatment session 77310 Teletherapy isodose plan; intermediate dynamic MLC, per treatment session 77315 Teletherapy Isodose plan; complex dynamic MLC, per treatment session 77321 Special Teletherapy port plan, particles, hemibody, total body dynamic MLC, per treatment session 77326 Brachytherapy Isodose Plan; simple Updated 3/19/2012 17
Description Description Source dynamic MLC, per treatment session 77327 Brachytherapy Isodose Plan; intermediate dynamic MLC, per treatment session 77328 Brachytherapy Isodose Plan; complex dynamic MLC, per treatment session 77331 Special radiation dosimetry IMRT Treatment Delivery; single or multiple fields/arcs, via dynamic MLC, per treatment session 77332 Treatment Devices; simple IMRT Treatment Delivery; single or multiple fields/arcs, via dynamic MLC, per treatment session 77333 Treatment Devices; intermediate IMRT Treatment Delivery; single or multiple fields/arcs, via dynamic MLC, per treatment session 77334 Treatment Devices; complex IMRT Treatment Delivery; single or multiple fields/arcs, via dynamic MLC, per treatment session 77338 Multi-leaf Collimator (MLC) device(s) for intensity modulated radiation theratpy (IMRT), design and construction per IMRT plan dynamic MLC, per treatment session Cobalt 60 based dynamic MLC, per treatment session of treatment of cerebral lesion(s) 1 session, linac based dynamic MLC, per treatment session fractions dynamic MLC, per treatment session 77401 Radiation treatment delivery; superficial and/or ortho voltage dynamic MLC, per treatment session 77402 dynamic MLC, per treatment session 77403 dynamic MLC, per treatment session 77404 19 MeV 10 MeV dynamic MLC, per treatment session 77406 Updated 3/19/2012 18
Description Description Source dynamic MLC, per treatment session 77407 blocks; up dynamic MLC, per treatment session 77408 blocks; 6-10 MeV dynamic MLC, per treatment session 77409 blocks; 11-19 MeV dynamic MLC, per treatment session 77411 blocks; 20 MeV or greater dynamic MLC, per treatment session 77412 dynamic MLC, per treatment session 77413 dynamic MLC, per treatment session 77414 dynamic MLC, per treatment session 77416 rotational beam, compensators, electron beam; up greater dynamic MLC, per treatment session 77422 Neutron beam tx, simple dynamic MLC, per treatment session 77423 Neutron beam tx, complex dynamic MLC, per treatment session 77432 Stereotactic radiation treatment management cerebral lesion(s) complete course of treatment consisting of 1 session dynamic MLC, per treatment session 77435 Stereotactic body radiation treatment management per treatment course; 1 or more lesions, including image guidance entire course not to exceed 5 fractions dynamic MLC, per treatment session 77470 Special Treatment Procedure (eg. Total body radiation, hemibody radiation, per oral endocavity or intraoperative cone irradiation) dynamic MLC, per treatment session 77520 Proton treatment delivery, simple w/o compensation dynamic MLC, per treatment session 77522 Proton treatment delivery, simple w/ compensation Updated 3/19/2012 19
Description Description Source dynamic MLC, per treatment session 77523 Proton treatment delivery, intermediate dynamic MLC, per treatment session 77525 Proton treatment delivery, complex dynamic MLC, per treatment session 0073T Compensator-based IMRT delivery dynamic MLC, per treatment session G0339 Robotic stereotactic surgery 1 session dynamic MLC, per treatment session G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77421 stereoscopic x-ray guidance for localization of target volume 76950 Ultrasound Localization of Radiation Therapy Fields 77421 stereoscopic x-ray guidance for localization of target volume 0197T Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (eg, 3D positional tracking, gating, 3D surface tracking), each fraction of treatment 77422 Neutron beam tx, simple 77520 Proton treatment delivery, simple w/o compensation 77423 Neutron beam tx, complex 77401 Radiation treatment delivery; superficial and/or ortho voltage 77423 Neutron beam tx, complex 77402 77423 Neutron beam tx, complex 77403 77423 Neutron beam tx, complex 77404 19 MeV 10 MeV 77423 Neutron beam tx, complex 77406 77423 Neutron beam tx, complex 77407 blocks; up 77423 Neutron beam tx, complex 77408 blocks; 6-10 MeV Updated 3/19/2012 20
Description Description Source 77423 Neutron beam tx, complex 77409 blocks; 11-19 MeV 77423 Neutron beam tx, complex 77411 blocks; 20 MeV or greater 77423 Neutron beam tx, complex 77422 Neutron beam tx, simple 77423 Neutron beam tx, complex 77520 Proton treatment delivery, simple w/o compensation 77427 Radiation treatment management, five treatments 77432 Stereotactic radiation treatment management cerebral lesion(s) complete course of treatment consisting of 1 session 77427 Radiation treatment management, five treatments G0339 Robotic stereotactic surgery 1 session 77427 Radiation treatment management, five treatments G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77431 77431 77431 77431 77432 77432 77435 therapy consisting of 1-2 fractions 76950 Ultrasound Localization of Radiation Therapy Fields therapy consisting of 1-2 fractions 77427 Radiation treatment management, five treatments therapy consisting of 1-2 fractions G0339 Robotic stereotactic surgery 1 session therapy consisting of 1-2 fractions Stereotactic radiation treatment management cerebral G0340 Robotic stereotactic radiosugery 2 through 5 sessions lesion(s) complete course of treatment consisting of 1 session 77421 stereoscopic x-ray guidance for localization of target volume Stereotactic radiation treatment management cerebral lesion(s) complete course of treatment consisting of 1 session 77431 therapy consisting of 1-2 fractions Stereotactic body radiation treatment management per treatment course; 1 or more lesions, including image guidance entire course not to exceed 5 fractions 77421 stereoscopic x-ray guidance for localization of target volume 77435 Stereotactic body radiation treatment management per treatment course; 1 or more lesions, including image guidance entire course not to exceed 5 fractions 77427 Radiation treatment management, five treatments 77435 Stereotactic body radiation treatment management per treatment course; 1 or more lesions, including image guidance entire course not to exceed 5 fractions 77431 therapy consisting of 1-2 fractions 77435 Stereotactic body radiation treatment management per treatment course; 1 or more lesions, including image guidance entire course not to exceed 5 fractions 77432 Stereotactic radiation treatment management cerebral lesion(s) complete course of treatment consisting of 1 session 77435 Stereotactic body radiation treatment management per treatment course; 1 or more lesions, including image guidance entire course not to exceed 5 fractions 77470 Special Treatment Procedure (eg. Total body radiation, hemibody radiation, per oral endocavity or intraoperative cone irradiation) 77470 77470 Special Treatment Procedure (eg. Total body radiation, hemibody radiation, per oral endocavity or intraoperative cone irradiation) 77432 Stereotactic radiation treatment management cerebral lesion(s) complete course of treatment consisting of 1 session Special Treatment Procedure (eg. Total body radiation, hemibody radiation, per oral endocavity or intraoperative cone irradiation) G0339 Robotic stereotactic surgery 1 session Updated 3/19/2012 21
77470 Description Description Source Special Treatment Procedure (eg. Total body radiation, hemibody radiation, per oral endocavity or intraoperative cone irradiation) G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77520 Proton treatment delivery, simple w/o compensation Cobalt 60 based 77520 Proton treatment delivery, simple w/o compensation of treatment of cerebral lesion(s) 1 session, linac based 77520 Proton treatment delivery, simple w/o compensation fractions 77520 Proton treatment delivery, simple w/o compensation 77401 Radiation treatment delivery; superficial and/or ortho voltage 77520 Proton treatment delivery, simple w/o compensation 77402 77520 Proton treatment delivery, simple w/o compensation 77403 77520 Proton treatment delivery, simple w/o compensation 77404 19 MeV 10 MeV 77520 Proton treatment delivery, simple w/o compensation 77406 77520 Proton treatment delivery, simple w/o compensation 77407 blocks; up 77520 Proton treatment delivery, simple w/o compensation 77408 blocks; 6-10 MeV 77520 Proton treatment delivery, simple w/o compensation 77409 blocks; 11-19 MeV 77520 Proton treatment delivery, simple w/o compensation 77411 blocks; 20 MeV or greater 77520 Proton treatment delivery, simple w/o compensation 77412 77520 Proton treatment delivery, simple w/o compensation 77413 rotational beam, compensators, electron beam; up Updated 3/19/2012 22
Description 77520 Proton treatment delivery, simple w/o compensation 77414 77520 Proton treatment delivery, simple w/o compensation 77416 Description Source greater 77520 Proton treatment delivery, simple w/o compensation G0251 Stereotactic, 2-5 Treatments 77520 Proton treatment delivery, simple w/o compensation G0339 Robotic stereotactic surgery 1 session 77520 Proton treatment delivery, simple w/o compensation G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77522 Proton treatment delivery, simple w/ compensation Cobalt 60 based 77522 Proton treatment delivery, simple w/ compensation of treatment of cerebral lesion(s) 1 session, linac based 77522 Proton treatment delivery, simple w/ compensation fractions 77522 Proton treatment delivery, simple w/ compensation 77401 Radiation treatment delivery; superficial and/or ortho voltage 77522 Proton treatment delivery, simple w/ compensation 77402 77522 Proton treatment delivery, simple w/ compensation 77403 77522 Proton treatment delivery, simple w/ compensation 77404 19 MeV 10 MeV 77522 Proton treatment delivery, simple w/ compensation 77406 77522 Proton treatment delivery, simple w/ compensation 77407 blocks; up 77522 Proton treatment delivery, simple w/ compensation 77409 blocks; 11-19 MeV 77522 Proton treatment delivery, simple w/ compensation 77411 blocks; 20 MeV or greater 77522 Proton treatment delivery, simple w/ compensation 77412 rotational beam, compensators, electron beam; up Updated 3/19/2012 23
Description 77522 Proton treatment delivery, simple w/ compensation 77413 77522 Proton treatment delivery, simple w/ compensation 77414 77522 Proton treatment delivery, simple w/ compensation 77416 Description Source greater 77522 Proton treatment delivery, simple w/ compensation 77520 Proton treatment delivery, simple w/o compensation 77522 Proton treatment delivery, simple w/ compensation G0251 Stereotactic, 2-5 Treatments 77522 Proton treatment delivery, simple w/ compensation G0339 Robotic stereotactic surgery 1 session 77522 Proton treatment delivery, simple w/ compensation G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77523 Proton treatment delivery, intermediate Cobalt 60 based 77523 Proton treatment delivery, intermediate of treatment of cerebral lesion(s) 1 session, linac based 77523 Proton treatment delivery, intermediate fractions 77523 Proton treatment delivery, intermediate 77401 Radiation treatment delivery; superficial and/or ortho voltage 77523 Proton treatment delivery, intermediate 77402 77523 Proton treatment delivery, intermediate 77403 77523 Proton treatment delivery, intermediate 77404 19 MeV 10 MeV 77523 Proton treatment delivery, intermediate 77406 Updated 3/19/2012 24
Description Description Source 77523 Proton treatment delivery, intermediate 77407 blocks; up 77523 Proton treatment delivery, intermediate 77408 blocks; 6-10 MeV 77523 Proton treatment delivery, intermediate 77409 blocks; 11-19 MeV 77523 Proton treatment delivery, intermediate 77411 blocks; 20 MeV or greater 77523 Proton treatment delivery, intermediate 77412 77523 Proton treatment delivery, intermediate 77413 77523 Proton treatment delivery, intermediate 77414 77523 Proton treatment delivery, intermediate 77416 rotational beam, compensators, electron beam; up greater 77523 Proton treatment delivery, intermediate 77520 Proton treatment delivery, simple w/o compensation 77523 Proton treatment delivery, intermediate 77522 Proton treatment delivery, simple w/ compensation 77523 Proton treatment delivery, intermediate G0251 Stereotactic, 2-5 Treatments 77523 Proton treatment delivery, intermediate G0339 Robotic stereotactic surgery 1 session 77523 Proton treatment delivery, intermediate G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77525 Proton treatment delivery, complex Cobalt 60 based 77525 Proton treatment delivery, complex of treatment of cerebral lesion(s) 1 session, linac based 77525 Proton treatment delivery, complex fractions 77525 Proton treatment delivery, complex 77401 Radiation treatment delivery; superficial and/or ortho voltage 77525 Proton treatment delivery, complex 77402 Updated 3/19/2012 25
Description Description Source 77525 Proton treatment delivery, complex 77403 77525 Proton treatment delivery, complex 77404 19 MeV 10 MeV 77525 Proton treatment delivery, complex 77406 77525 Proton treatment delivery, complex 77407 blocks; up 77525 Proton treatment delivery, complex 77408 blocks; 6-10 MeV 77525 Proton treatment delivery, complex 77409 blocks; 11-19 MeV 77525 Proton treatment delivery, complex 77411 blocks; 20 MeV or greater 77525 Proton treatment delivery, complex 77412 77525 Proton treatment delivery, complex 77413 77525 Proton treatment delivery, complex 77414 77525 Proton treatment delivery, complex 77416 rotational beam, compensators, electron beam; up greater 77525 Proton treatment delivery, complex 77520 Proton treatment delivery, simple w/o compensation 77525 Proton treatment delivery, complex 77522 Proton treatment delivery, simple w/ compensation 77525 Proton treatment delivery, complex 77523 Proton treatment delivery, intermediate 77525 Proton treatment delivery, complex G0251 Stereotactic, 2-5 Treatments 77525 Proton treatment delivery, complex G0339 Robotic stereotactic surgery 1 session 77525 Proton treatment delivery, complex G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77600 Hyperthermia treatment; externally generated, deep 77261 Therapeutic Radiology treatment planning;simple 77600 Hyperthermia treatment; externally generated, deep 77262 Therapeutic Radiology treatment planning; intermediate 77600 Hyperthermia treatment; externally generated, deep 77263 Therapeutic Radiology treatment planning; complex 77600 Hyperthermia treatment; externally generated, deep 77300 Basic Radiation Dosimetry Updated 3/19/2012 26
Description Description Source 77600 Hyperthermia treatment; externally generated, deep 77331 Special radiation dosimetry 77600 Hyperthermia treatment; externally generated, deep 77332 Treatment Devices; simple 77600 Hyperthermia treatment; externally generated, deep 77333 Treatment Devices; intermediate 77600 Hyperthermia treatment; externally generated, deep 77334 Treatment Devices; complex 77600 Hyperthermia treatment; externally generated, deep 77336 Continuing medical physics consultation 77600 Hyperthermia treatment; externally generated, deep 77370 Special medical physics consultation 77600 Hyperthermia treatment; externally generated, deep 77610 applicators 77600 Hyperthermia treatment; externally generated, deep 77615 Hyperthermia generated by interstitial probe(s); 5 or more applicators 77600 Hyperthermia treatment; externally generated, deep 77620 Hyperthermia generated by intracavitary probe(s) 77605 77605 77605 77605 77605 77605 77605 77605 77605 77605 applicators 77261 Therapeutic Radiology treatment planning;simple applicators 77262 Therapeutic Radiology treatment planning; intermediate applicators 77263 Therapeutic Radiology treatment planning; complex applicators 77300 Basic Radiation Dosimetry applicators 77331 Special radiation dosimetry applicators 77332 Treatment Devices; simple applicators 77333 Treatment Devices; intermediate applicators 77334 Treatment Devices; complex applicators 77336 Continuing medical physics consultation applicators 77370 Special medical physics consultation 77605 Hyperthermia treatment; externally generated, superficial 77600 Hyperthermia treatment; externally generated, deep 77605 Hyperthermia treatment; externally generated, superficial 77610 77605 Hyperthermia treatment; externally generated, superficial 77615 applicators Hyperthermia generated by interstitial probe(s); 5 or more applicators 77605 Hyperthermia treatment; externally generated, superficial 77620 Hyperthermia generated by intracavitary probe(s) 77610 77610 77610 77610 77610 77610 applicators 77261 Therapeutic Radiology treatment planning;simple applicators 77262 Therapeutic Radiology treatment planning; intermediate applicators 77263 Therapeutic Radiology treatment planning; complex applicators 77300 Basic Radiation Dosimetry applicators 77331 Special radiation dosimetry applicators 77332 Treatment Devices; simple Updated 3/19/2012 27
77610 77610 77610 77610 77610 77610 77615 77615 77615 77615 77615 77615 77615 77615 77615 77615 77615 77615 Description Description Source applicators 77333 Treatment Devices; intermediate applicators 77334 Treatment Devices; complex applicators 77336 Continuing medical physics consultation applicators 77370 Special medical physics consultation applicators 77600 Hyperthermia treatment; externally generated, deep applicators 77620 Hyperthermia generated by intracavitary probe(s) Hyperthermia generated by interstitial probe(s); 5 or more applicators 77261 Therapeutic Radiology treatment planning;simple Hyperthermia generated by interstitial probe(s); 5 or more applicators 77262 Therapeutic Radiology treatment planning; intermediate Hyperthermia generated by interstitial probe(s); 5 or more applicators 77263 Therapeutic Radiology treatment planning; complex Hyperthermia generated by interstitial probe(s); 5 or more applicators 77300 Basic Radiation Dosimetry Hyperthermia generated by interstitial probe(s); 5 or more applicators 77331 Special radiation dosimetry Hyperthermia generated by interstitial probe(s); 5 or more applicators 77332 Treatment Devices; simple Hyperthermia generated by interstitial probe(s); 5 or more applicators 77333 Treatment Devices; intermediate Hyperthermia generated by interstitial probe(s); 5 or more applicators 77334 Treatment Devices; complex Hyperthermia generated by interstitial probe(s); 5 or more applicators 77336 Continuing medical physics consultation Hyperthermia generated by interstitial probe(s); 5 or more applicators 77370 Special medical physics consultation Hyperthermia generated by interstitial probe(s); 5 or more applicators 77610 applicators applicators 77620 Hyperthermia generated by intracavitary probe(s) 77620 Hyperthermia generated by intracavitary probe(s) 77261 Therapeutic Radiology treatment planning;simple 77620 Hyperthermia generated by intracavitary probe(s) 77262 Therapeutic Radiology treatment planning; intermediate 77620 Hyperthermia generated by intracavitary probe(s) 77263 Therapeutic Radiology treatment planning; complex 77620 Hyperthermia generated by intracavitary probe(s) 77300 Basic Radiation Dosimetry 77620 Hyperthermia generated by intracavitary probe(s) 77331 Special radiation dosimetry 77620 Hyperthermia generated by intracavitary probe(s) 77332 Treatment Devices; simple 77620 Hyperthermia generated by intracavitary probe(s) 77333 Treatment Devices; intermediate 77620 Hyperthermia generated by intracavitary probe(s) 77334 Treatment Devices; complex 77620 Hyperthermia generated by intracavitary probe(s) 77336 Continuing medical physics consultation Updated 3/19/2012 28
Description Description Source 77620 Hyperthermia generated by intracavitary probe(s) 77370 Special medical physics consultation 77750 77750 77750 77750 77750 77750 Infusion or instillation of radioelement solution (includes 3- month follow-up care) 77336 Continuing medical physics consultation Infusion or instillation of radioelement solution (includes 3- month follow-up care) 77427 Radiation treatment management, five treatments Infusion or instillation of radioelement solution (includes 3- month follow-up care) 77431 Infusion or instillation of radioelement solution (includes 3- month follow-up care) 77785 Infusion or instillation of radioelement solution (includes 3- month follow-up care) 77786 Infusion or instillation of radioelement solution (includes 3- month follow-up care) 77787 therapy consisting of 1-2 fractions brachytherapy; 1 channel brachytherapy; 2-12 channels brachytherapy; over 12 channels 77761 Intracavitary radiation source application; simple 77336 Continuing medical physics consultation 77761 Intracavitary radiation source application; simple 77427 Radiation treatment management, five treatments 77761 Intracavitary radiation source application; simple 77431 77761 Intracavitary radiation source application; simple 77785 77761 Intracavitary radiation source application; simple 77786 77761 Intracavitary radiation source application; simple 77787 therapy consisting of 1-2 fractions brachytherapy; 1 channel brachytherapy; 2-12 channels brachytherapy; over 12 channels 77761 Intracavitary radiation source application; simple 0182T High dose rate electronic brachytherapy, per fraction 77762 Intracavitary radiation source application; intermediate 77336 Continuing medical physics consultation 77762 Intracavitary radiation source application; intermediate 77427 Radiation treatment management, five treatments 77762 Intracavitary radiation source application; intermediate 77431 therapy consisting of 1-2 fractions 77762 Intracavitary radiation source application; intermediate 77761 Intracavitary radiation source application; simple 77762 Intracavitary radiation source application; intermediate 77785 77762 Intracavitary radiation source application; intermediate 77786 77762 Intracavitary radiation source application; intermediate 77787 brachytherapy; 1 channel brachytherapy; 2-12 channels brachytherapy; over 12 channels 77762 Intracavitary radiation source application; intermediate 0182T High dose rate electronic brachytherapy, per fraction 77763 Intracavitary radiation source application; complex 77336 Continuing medical physics consultation 77763 Intracavitary radiation source application; complex 77431 therapy consisting of 1-2 fractions 77763 Intracavitary radiation source application; complex 77761 Intracavitary radiation source application; simple 77763 Intracavitary radiation source application; complex 77762 Intracavitary radiation source application; intermediate 77763 Intracavitary radiation source application; complex 77785 brachytherapy; 1 channel Updated 3/19/2012 29
Description 77763 Intracavitary radiation source application; complex 77786 77763 Intracavitary radiation source application; complex 77787 Description Source brachytherapy; 2-12 channels brachytherapy; over 12 channels 77763 Intracavitary radiation source application; complex 0182T High dose rate electronic brachytherapy, per fraction 77776 Interstitial radiation source; simple 77336 Continuing medical physics consultation 77776 Interstitial radiation source; simple 77427 Radiation treatment management, five treatments 77776 Interstitial radiation source; simple 77431 therapy consisting of 1-2 fractions 77776 Interstitial radiation source; simple 77761 Intracavitary radiation source application; simple 77776 Interstitial radiation source; simple 77762 Intracavitary radiation source application; intermediate 77776 Interstitial radiation source; simple 77763 Intracavitary radiation source application; complex 77776 Interstitial radiation source; simple 77785 77776 Interstitial radiation source; simple 77786 77776 Interstitial radiation source; simple 77787 brachytherapy; 1 channel brachytherapy; 2-12 channels brachytherapy; over 12 channels 77776 Interstitial radiation source; simple 0182T High dose rate electronic brachytherapy, per fraction 77777 Interstitial radiation source; intermediate 77336 Continuing medical physics consultation 77777 Interstitial radiation source; intermediate 77427 Radiation treatment management, five treatments 77777 Interstitial radiation source; intermediate 77431 therapy consisting of 1-2 fractions 77777 Interstitial radiation source; intermediate 77761 Intracavitary radiation source application; simple 77777 Interstitial radiation source; intermediate 77762 Intracavitary radiation source application; intermediate 77777 Interstitial radiation source; intermediate 77763 Intracavitary radiation source application; complex 77777 Interstitial radiation source; intermediate 77776 Interstitial radiation source; simple 77777 Interstitial radiation source; intermediate 0182T High dose rate electronic brachytherapy, per fraction 77778 Interstitial radiation source; complex 77336 Continuing medical physics consultation 77778 Interstitial radiation source; complex 77427 Radiation treatment management, five treatments 77778 Interstitial radiation source; complex 77431 therapy consisting of 1-2 fractions 77778 Interstitial radiation source; complex 77761 Intracavitary radiation source application; simple 77778 Interstitial radiation source; complex 77762 Intracavitary radiation source application; intermediate 77778 Interstitial radiation source; complex 77763 Intracavitary radiation source application; complex Updated 3/19/2012 30
Description Description Source 77778 Interstitial radiation source; complex 77776 Interstitial radiation source; simple 77778 Interstitial radiation source; complex 77777 Interstitial radiation source; intermediate 77778 Interstitial radiation source; complex 77785 77778 Interstitial radiation source; complex 77786 77778 Interstitial radiation source; complex 77787 brachytherapy; 1 channel brachytherapy; 2-12 channels brachytherapy; over 12 channels 77778 Interstitial radiation source; complex 77789 Apply surface radiation 77778 Interstitial radiation source; complex 0182T High dose rate electronic brachytherapy, per fraction 77785 77785 77785 77785 77786 77786 77786 77786 77786 77786 77787 77787 77787 77787 77787 77787 77787 brachytherapy; 1 channel 77336 Continuing medical physics consultation brachytherapy; 1 channel 77427 Radiation treatment management, five treatments brachytherapy; 1 channel 77790 Radio Isotope Supervision, Handling, Loading brachytherapy; 1 channel 0182T High dose rate electronic brachytherapy, per fraction brachytherapy; 2-12 channels 77336 Continuing medical physics consultation brachytherapy; 2-12 channels 77427 Radiation treatment management, five treatments brachytherapy; 2-12 channels 77431 brachytherapy; 2-12 channels 77785 therapy consisting of 1-2 fractions brachytherapy; 1 channel brachytherapy; 2-12 channels 77790 Radio Isotope Supervision, Handling, Loading brachytherapy; 2-12 channels 0182T High dose rate electronic brachytherapy, per fraction brachytherapy; over 12 channels 77336 Continuing medical physics consultation brachytherapy; over 12 channels 77427 Radiation treatment management, five treatments brachytherapy; over 12 channels 77431 brachytherapy; over 12 channels 77785 brachytherapy; over 12 channels 77786 therapy consisting of 1-2 fractions brachytherapy; 1 channel brachytherapy; 2-12 channels brachytherapy; over 12 channels 77790 Radio Isotope Supervision, Handling, Loading brachytherapy; over 12 channels 0182T High dose rate electronic brachytherapy, per fraction 77789 Apply surface radiation 77336 Continuing medical physics consultation 77789 Apply surface radiation 77427 Radiation treatment management, five treatments 77789 Apply surface radiation 77431 therapy consisting of 1-2 fractions Updated 3/19/2012 31
Description Description Source 77789 Apply surface radiation 77790 Radio Isotope Supervision, Handling, Loading 77789 Apply surface radiation 0182T High dose rate electronic brachytherapy, per fraction 77790 Radio Isotope Supervision, Handling, Loading 77336 Continuing medical physics consultation 77790 Radio Isotope Supervision, Handling, Loading 77427 Radiation treatment management, five treatments 77790 Radio Isotope Supervision, Handling, Loading 77431 therapy consisting of 1-2 fractions 0073T Compensator-based IMRT delivery 76965 Ultrasound guidance for interstitial radioelement application 0073T Compensator-based IMRT delivery 77261 Therapeutic Radiology treatment planning;simple 0073T Compensator-based IMRT delivery 77262 Therapeutic Radiology treatment planning; intermediate 0073T Compensator-based IMRT delivery 77263 Therapeutic Radiology treatment planning; complex 0073T Compensator-based IMRT delivery 77305 Teletherapy isodose plan simple 0073T Compensator-based IMRT delivery 77310 Teletherapy isodose plan; intermediate 0073T Compensator-based IMRT delivery 77315 Teletherapy Isodose plan; complex 0073T Compensator-based IMRT delivery 77321 Special Teletherapy port plan, particles, hemibody, total body 0073T Compensator-based IMRT delivery 77326 Brachytherapy Isodose Plan; simple 0073T Compensator-based IMRT delivery 77327 Brachytherapy Isodose Plan; intermediate 0073T Compensator-based IMRT delivery 77328 Brachytherapy Isodose Plan; complex 0073T Compensator-based IMRT delivery 77331 Special radiation dosimetry 0073T Compensator-based IMRT delivery 77338 Multi-leaf Collimator (MLC) device(s) for intensity modulated radiation theratpy (IMRT), design and construction per IMRT plan CPT/AMA 0073T Compensator-based IMRT delivery 77401 Radiation treatment delivery; superficial and/or ortho voltage 0073T Compensator-based IMRT delivery 77402 0073T Compensator-based IMRT delivery 77403 0073T Compensator-based IMRT delivery 77404 0073T Compensator-based IMRT delivery 77406 0073T Compensator-based IMRT delivery 77407 19 MeV 10 MeV blocks; up Updated 3/19/2012 32
Pay Description Description Source 0073T Compensator-based IMRT delivery 77408 blocks; 6-10 MeV 0073T Compensator-based IMRT delivery 77409 blocks; 11-19 MeV 0073T Compensator-based IMRT delivery 77411 blocks; 20 MeV or greater 0073T Compensator-based IMRT delivery 77412 rotational beam, compensators, y; electron beam; p up 0073T Compensator-based IMRT delivery 77413 y; p 0073T Compensator-based IMRT delivery 77414 0073T Compensator-based IMRT delivery 77416 greater 0073T Compensator-based IMRT delivery 77422 Neutron beam tx, simple 0073T Compensator-based IMRT delivery 77423 Neutron beam tx, complex 0073T Compensator-based IMRT delivery 77432 Stereotactic radiation treatment management cerebral lesion(s) complete course of treatment consisting of 1 session 0073T Compensator-based IMRT delivery 77435 Stereotactic body radiation treatment management per treatment course; 1 or more lesions, including image guidance entire course not to exceed 5 fractions 0073T Compensator-based IMRT delivery 77470 Special Treatment Procedure (eg. Total body radiation, hemibody radiation, per oral endocavity or intraoperative cone irradiation) 0073T Compensator-based IMRT delivery 77520 Proton treatment delivery, simple w/o compensation 0073T Compensator-based IMRT delivery 77522 Proton treatment delivery, simple w/ compensation 0073T Compensator-based IMRT delivery 77523 Proton treatment delivery, intermediate 0073T Compensator-based IMRT delivery 77525 Proton treatment delivery, complex 0073T Compensator-based IMRT delivery G0339 Robotic stereotactic surgery 1 session 0073T Compensator-based IMRT delivery G0340 Robotic stereotactic radiosugery 2 through 5 sessions G0173 Stereotactic, One Treatment 77321 Special Teletherapy port plan, particles, hemibody, total body G0173 Stereotactic, One Treatment 77326 Brachytherapy Isodose Plan; simple G0173 Stereotactic, One Treatment 77327 Brachytherapy Isodose Plan; intermediate G0173 Stereotactic, One Treatment 77328 Brachytherapy Isodose Plan; complex G0173 Stereotactic, One Treatment 77336 Continuing medical physics consultation G0173 Stereotactic, One Treatment Cobalt 60 based Updated 3/19/2012 33
Description Description Source G0173 Stereotactic, One Treatment of treatment of cerebral lesion(s) 1 session, linac based G0173 Stereotactic, One Treatment fractions G0173 Stereotactic, One Treatment dynamic MLC, per treatment session G0173 Stereotactic, One Treatment 77421 stereoscopic x-ray guidance for localization of target volume G0173 Stereotactic, One Treatment 77427 Radiation treatment management, five treatments G0173 Stereotactic, One Treatment 77431 G0173 Stereotactic, One Treatment 77470 therapy consisting of 1-2 fractions Special Treatment Procedure (eg. Total body radiation, hemibody radiation, per oral endocavity or intraoperative cone irradiation) G0173 Stereotactic, One Treatment G0251 Stereotactic, 2-5 Treatments G0173 Stereotactic, One Treatment G0339 Robotic stereotactic surgery 1 session G0173 Stereotactic, One Treatment G0340 Robotic stereotactic radiosugery 2 through 5 sessions G0251 Stereotactic, 2-5 Treatments 77326 Brachytherapy Isodose Plan; simple G0251 Stereotactic, 2-5 Treatments 77327 Brachytherapy Isodose Plan; intermediate G0251 Stereotactic, 2-5 Treatments 77328 Brachytherapy Isodose Plan; complex G0251 Stereotactic, 2-5 Treatments 77401 Radiation treatment delivery; superficial and/or ortho voltage G0251 Stereotactic, 2-5 Treatments 77402 G0251 Stereotactic, 2-5 Treatments 77403 G0251 Stereotactic, 2-5 Treatments 77404 G0251 Stereotactic, 2-5 Treatments 77406 G0251 Stereotactic, 2-5 Treatments 77407 G0251 Stereotactic, 2-5 Treatments 77408 G0251 Stereotactic, 2-5 Treatments 77411 G0251 Stereotactic, 2-5 Treatments 77412 19 MeV 10 MeV blocks; up blocks; 6-10 MeV blocks; 20 MeV or greater rotational beam, compensators, electron beam; up Updated 3/19/2012 34
Pay Description y; Description p Source G0251 Stereotactic, 2-5 Treatments 77413 y; p G0251 Stereotactic, 2-5 Treatments 77414 y; p G0251 Stereotactic, 2-5 Treatments 77416 greater G0251 Stereotactic, 2-5 Treatments dynamic MLC, per treatment session G0251 Stereotactic, 2-5 Treatments 77421 stereoscopic x-ray guidance for localization of target volume G0251 Stereotactic, 2-5 Treatments 77422 Neutron beam tx, simple G0251 Stereotactic, 2-5 Treatments 77423 Neutron beam tx, complex G0251 Stereotactic, 2-5 Treatments 0073T Compensator-based IMRT delivery G0251 Stereotactic, 2-5 Treatments G0339 Robotic stereotactic surgery 1 session G0251 Stereotactic, 2-5 Treatments G0340 Robotic stereotactic radiosugery 2 through 5 sessions G0339 Robotic stereotactic surgery 1 session 77321 Special Teletherapy port plan, particles, hemibody, total body G0339 Robotic stereotactic surgery 1 session 77326 Brachytherapy Isodose Plan; simple G0339 Robotic stereotactic surgery 1 session 77327 Brachytherapy Isodose Plan; intermediate G0339 Robotic stereotactic surgery 1 session 77328 Brachytherapy Isodose Plan; complex G0339 Robotic stereotactic surgery 1 session 77336 Continuing medical physics consultation G0339 Robotic stereotactic surgery 1 session 77401 Radiation treatment delivery; superficial and/or ortho voltage G0339 Robotic stereotactic surgery 1 session 77402 G0339 Robotic stereotactic surgery 1 session 77403 G0339 Robotic stereotactic surgery 1 session 77404 G0339 Robotic stereotactic surgery 1 session 77406 G0339 Robotic stereotactic surgery 1 session 77407 G0339 Robotic stereotactic surgery 1 session 77408 G0339 Robotic stereotactic surgery 1 session 77409 G0339 Robotic stereotactic surgery 1 session 77411 19 MeV 10 MeV blocks; up blocks; 6-10 MeV blocks; 11-19 MeV blocks; 20 MeV or greater Updated 3/19/2012 35
Pay Description Description Source G0339 Robotic stereotactic surgery 1 session 77412 rotational beam, compensators, y; electron beam; p up G0339 Robotic stereotactic surgery 1 session 77413 y; p G0339 Robotic stereotactic surgery 1 session 77414 y; p G0339 Robotic stereotactic surgery 1 session 77416 greater G0339 Robotic stereotactic surgery 1 session 77421 stereoscopic x-ray guidance for localization of target volume G0339 Robotic stereotactic surgery 1 session 77422 Neutron beam tx, simple G0339 Robotic stereotactic surgery 1 session 77423 Neutron beam tx, complex G0339 Robotic stereotactic surgery 1 session G0340 Robotic stereotactic radiosugery 2 through 5 sessions G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77321 Special Teletherapy port plan, particles, hemibody, total body G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77326 Brachytherapy Isodose Plan; simple G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77327 Brachytherapy Isodose Plan; intermediate G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77328 Brachytherapy Isodose Plan; complex G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77401 Radiation treatment delivery; superficial and/or ortho voltage G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77402 G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77403 G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77404 G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77406 G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77407 G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77408 G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77409 G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77411 G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77412 19 MeV 10 MeV blocks; up blocks; 6-10 MeV blocks; 11-19 MeV blocks; 20 MeV or greater rotational beam, compensators, electron beam; up Updated 3/19/2012 36
Pay Description y; Description p Source G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77413 y; p G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77414 y; p G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77416 greater G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77421 stereoscopic x-ray guidance for localization of target volume G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77422 Neutron beam tx, simple G0340 Robotic stereotactic radiosugery 2 through 5 sessions 77423 Neutron beam tx, complex Updated 3/19/2012 37