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0197T

Karen Posted Mon 28th of November, 2011 18:08:47 PM

Currently we are not being reimbursed for 0197T and it is my understanding that this code is not billable with 77421 & 77014. If steretactic guidance 77421 or CBCT 77014 is done in conjunction with gating how should we bill? Should we not report 0197T and only report the codes we get reimbursed for ?

SuperCoder Answered Mon 28th of November, 2011 19:35:30 PM

Category III CPT code 0197T has no relative value units (RVUs) or payment assigned under the Medicare Physician Fee Schedule. With the exception of compensator-based IMRT (CPT 0073T), all of the Category III CPT codes are "carrier" priced, meaning that physicians and freestanding centers will need to contact their Medicare contractor to negotiate coverage and payment.
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0197T Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (e.g., 3D positional tracking, gating, 3D surface tracking), each fraction of treatment.
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In the hospital outpatient setting, 0197T is considered image guidance and is packaged into the primary service payment. There is no separate payment for 0197T in the hospital outpatient setting.

Karen Posted Tue 29th of November, 2011 19:15:12 PM

Thank You Andrew, I would like to confirm if I am understaning you correctly. I have found out that our local carrier NHIC started paying for 0197T effective 11/4/2010. We are hospital based...should we not be charging for this code at all because we are hopsital based and if so would it be ok to charge for the77421 or 77014 as appropriate?

SuperCoder Answered Tue 29th of November, 2011 20:02:20 PM

Yes, being hospital based you should not be charging for this, rather you should be charging for 77421 or 77014 as appropriate.
Reference:
http://www.aapm.org/government_affairs/CMS/documents/CodingFAQs2009FINAL04-09.doc

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