Jenneta Posted Wed 29th of April, 2015 12:02:10 PM
I submitted 5 units for 77300 to medicaid and the response was " CPT 77300 CAN NOT BILL WITH 5 UNITS." I understand that the claim can be appealed but can you tell me the allowed amount?
SuperCoder Answered Thu 30th of April, 2015 02:13:47 AM
Medicare fees for facility would be: $63.29
Medicare fees for non facility would be: $63.29
For professional component services: $32.18
For technical component services: $31.11
Jenneta Posted Fri 08th of May, 2015 15:41:30 PM
I'm sorry I wasn't clear in my question. What is the allowed or billable amount of Units for CPT code 77300 and how often can bill once I've reached the maximum amount.
SuperCoder Answered Mon 11th of May, 2015 03:30:38 AM
Units billed depends on the treatment provided to the patient.
Please find below the link for better understanding.
Jenneta Posted Tue 12th of May, 2015 12:27:40 PM
(Your subscription does not include access to articles published in Oncology & Hematology Coding Alert.)
Thank you for your help but I'm unable to read the article
SuperCoder Answered Wed 13th of May, 2015 03:19:56 AM
If the patient requires a new calculation during treatment, because of weight change, for example, you may code 77300 again but two parallel opposed ports with the same parameters may require one calculation for both. Medicare may expect one to eight calculations during the initial course of therapy. You may charge additional calculations for each boost (cone-down). Payers may deny charges that exceed this number. Some coders report having to appeal any claim for more than four calculations. Others have gotten word from their contractor to bill up to 10 units on a single line and put additional units on a separate line with modifier 76 (Repeat procedure or service by same physician). You may also find some payers who allow you to bill only one service per treatment area (such as the pelvis) regardless of the number of ports.
If you are receiving denials for multiple units, be sure to ask your payer for its policy -- in writing -- on reporting multiple 77300 services. If your payer has a frequency/medically unlikely edit in place, be sure you find out how to override the edit for medically necessary services. Some payers may ask for modifier 76, modifier 59 (Distinct procedural service), or modifier GD (Units of service exceeds medically unlikely edit value and represents reasonable and necessary services).
Learn by Doing With 2 Examples
Assuming your payer allows you to report each necessary calculation, decide how many times you would report 77300 for these examples. Note that MU stands for monitor units -- the time the treatment unit is in beam on mode.
Example 1: The patient requires treatment for his pelvis with four fields per day: anterior, posterior, right lateral, and left lateral. The parameters for the AP and PA pelvis are the same. You are reporting the professional service only.
AP Pelvis PA Pelvis RT Lat Pelvis LT Lat Pelvis
90 MU 90 MU 57 MU 59 MU
Solution: Report 77300-26 (Professional component) three times -- once for the right lateral, once for the left lateral, and once total for the AP and PA pelvis. (When two parallel opposed ports have the same parameters -- mirror image calculations --you should report only one 77300 service for both ports.
Example 2: A stereotactic radiosurgery patient requires six treatment fields and all six have different monitor units calculated. You are reporting the professional service only.
Field 1 Field 2 Field 3 Field 4 Field 5 Field 6
77 MU 75 MU 90 MU 85 MU 72 MU 70 MU
Solution: Bill six 77300-26 charges (77300-26 x 6.
Hope this information will be helpful.
Jenneta Posted Thu 14th of May, 2015 09:15:55 AM
yes, this is very helpful. thank you
SuperCoder Answered Thu 14th of May, 2015 15:17:54 PM