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Julie Posted Tue 29th of August, 2017 19:49:33 PM
A physician performs temporary marker placement for HDR brachytherapy for simulation of the source dwell locations prior to each fraction. Is there a frequency limit for the hospital when billing the fiducial marker placement (49411) and markers (A4648). It appears we can bill and get paid for each fraction of treatment but would like confirmation on that interpretation.
SuperCoder Answered Wed 30th of August, 2017 08:35:30 AM

Hi,

As per CMS CPT code 49411 and HCPCS code A4648 are billable when same date of service is listed for both codes.

Separate payment for implantable tissue markers and radiation dosimeters will not be made under the Hospital Out-Patient Prospective Payment System (HOPPS), 

In-Patient Prospective Payment System (IPPS) or Ambulatory Surgery Center, as payment for these supplies is packaged into the payment for the service for which the supply is provided or is bundled into the Diagnosis-Related Group (DRG)

Hope this helps!

Julie Posted Wed 30th of August, 2017 19:58:44 PM
Thanks - so to clarify the MR markers would be placed for each fraction (depending on the patient and complexity of the implant) to simulate the implant and determine the path and dwell locations of the Iridium Source in the HDR applicator(s). Gyn patients may have 5 fractions over as many days and could have up to 7 (or more) applicators/channels that would need to be simulated for each fraction. Each one of those marker placement procedures are billable using 49411? There is no frequency or per course of treatment limit?
SuperCoder Answered Fri 01st of September, 2017 08:18:17 AM

Hi,

Report 49411 only once no matter how many markers the provider places. As per the Medicare hospital outpatient prospective payment system (OPPS) and the ambulatory surgical center (ASC) payment system, carriers and A/B MACS do not pay hospitals or ASCs separately for HCPCS codes A4648 (Tissue marker, implantable, any type, each) or A4650 (Implantable radiation dosimeter each); rather, payment for these codes is packaged into the payment for the service in which they are used. Similarly, under the Medicare inpatient prospective payment system (IPPS), payment for these services is bundled into the MS-DRG payment. 

Hospitals that are not paid under the OPPS or IPPS are paid for HCPCS code A4648 under a variety of other payment mechanisms. however, 49411 is  separately billable, and payable, when billed by physicians.

 Hope this helps!

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