(Medicare Claims Processing Manual)

If billings have occurred which indicate that the treatment course has ended (and, therefore, the number of residual fractions has been determined), but treatments resume, adjust A/B MAC (B) payments for the additional services consistent with the above policy.  EXAMPLE:  8 fractions = payment for 2 weeks  2 additional fractions are furnished by the same physician.  No additional Medicare payment is made for the 2 additional fractions. A.  SNF Treatment Management Delivery Services   A SNF may not bill weekly treatment management services for its outpatients (codes 77419, 77420, 77425, 77430, and 77431).  Instead, the SNF should bill for radiation treatment delivery (codes 77401 -  77404, 77406 -  77409, 77411 -  77414, and 77416).  Also,  SNFs bill for therapeutic radiology port film (code 77417), which was previously a part of the weekly services.  They enter the number of services in the units field.   70.2 - Services Bundled Into Treatment Management Codes  (Rev. 4267, Issued: 03- 27-19, Effective: 01 -01-19, Implementation: 03- 25-19)  A/B MACs (B) do not make separate payment for services rendered by the radiation oncologists or in conjunction with radiation therapy.   11920 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin; 6.0 sq. cm or less  11921 6.11 to 20.0 sq. cm  11922 Each additional 20.0 sq. cm  16000 Initial treatment, first- degree burn, when no more than local treatment is required  16010 Dressings and/or debridement, initial or subsequent; under anesthesia, small 16015 Under anesthesia, medium or large, or with major debridement  16020 Without anesthesia, office  or hospital, small  16025 Without anesthesia, medium (e.g., whole face or whole extremity)  16030 Without anesthesia, large (e.g., more than one extremity)  36425 Venipuncture, cut down age 1 or over  53670 Catheterization, urethra; simple  53675 Complicated (may include difficult removal of balloon catheter)  99211 Office or other outpatient visit, established patient; Level I*  99212 Level II*  99213 Level III*  99214 Level IV  99215 Level V  99238 Hospital discharge day management  99281 Emergency department visit, new or established patient; Level I  99282 Level II  99283 Level III  99284 Level IV  99285 Level V  90780 IV Infusion therapy, administered by physician or under direct supervision of physician; up to one hour  90781 Each additional hour, up to 8 hours  90847 Family medical psychotherapy (conjoint psychotherapy) by a physician, with continuing medical diagnostic evaluation, and drug management when indicated  99050 Services requested after office hours in addition to basic service  99052 Services requested between 10:00 PM and 8:00 AM in addition to basic service  99054 Services requested on Sundays and holidays in addition to basic service   99058 Office services provided on an emergency basis  99071 Educational supplies, such as books, tapes, and pamphlets, provided by the physician for the patients education at cost to physician 99090 Analysis of information data stored in computers (e.g., ECG, blood pressures, hematologic data)  99185 Hypothermia; regional  99371 Telephone call by a physician to patient or for consultation or medical management or for coordinating medical management with other health care professionals; simple or brief (e.g., to report on tests and/or laboratory results, to clarify or alter previous instructions, to integrate new information fro m other health professionals into the medical treatment plan, or to adjust therapy)  99372 Intermediate (e.g., to provide advice to an established patient on a new problem, to initiate therapy that can be handled by telephone, to discuss test results in detail, to coordinate medical management of a new problem in an established patient, to discuss and evaluate new information and details, or to initiate a new plan of care)  99373 Complex or lengthy (e.g., lengthy counseling session with anxious or distraught patient, detailed or prolonged discussion with family members regarding seriously ill patient, lengthy communication necessary to coordinate complex services or several d ifferent health professionals working on different aspects of the total patient care plan)   Anesthesia (whatever code billed)   Care of Infected Skin (whatever code billed)   Checking of Treatment Charts   Verification of Dosage, As Needed (whatever code billed)   Continued Patient Evaluation, Examination,  Written Progress Notes, As Needed (whatever code billed)   Final Physical  Examination (whatever code billed)   Medical Prescription Writing (whatever code billed   Nutritional Counseling (whatever code billed)   Pain Management (whatever code billed)   Review & Revision of Treatment Plan (whatever code billed)   Routine Medical Management of Unrelated Problem (whatever code billed)   Special Care of Ostomy (whatever code billed)   Written Reports, Progress Note (whatever code billed)   Follow -up Examination and Care for 90 Days After Last Treatment (whatever code billed)   *NOTE: May be billed with Radiation Treatment Delivery, superficial and/or ortho voltage, for the purpose of reporting physician services consisting of radiation therapy planning (including, but not limited to clinical treatment planning, isodose planning, physics consultation), radiation treatment device construction, and radiation treatment management when performed on the same date of service as treatment delivery. Billing with modifier 25 may be necessary if National Correct Coding Initiative (NCCI) edi ts apply.  70.3 - Radiation Treatment Delivery (CPT 77401 - 77417)  (Rev. 1, 10- 01-03)  A/B MACs (B) pay for these TC services on a daily basis  under CPT codes 77401- 77416 for radiation treatment delivery.  They do not use local codes and RVUs in paying for the TC of radiation oncology services.  Multiple treatment sessions on the same day are payable as long as there has been a distinct break in  therapy services, and the individual sessions are of the character usually furnished on different days.  A/B MACs (B) pay for CPT code 77417 (Therapeutic radiology port film(s)) on a weekly (five fractions) basis.  70.4 - Clinical Brachytherapy (CPT Codes 77750 - 77799)  (Rev. 1, 10- 01-03)  A/B MACs (B) must apply the bundled services policy to procedures in this family of codes other than CPT code 77776.  For procedures furnished in settings in which TC payments are made, A/B MACs (B) must pay separately for the expendable source associated with these procedures under CPT code 79900 except in the case of remote after-loading high intensity brachytherapy procedures (CPT codes 77781- 77784).  In the four codes cited, the expendable source is included in the RVUs for the TC of the procedures.   70.5 - Radiation Physics Services (CPT Codes 77300 - 77399)  (Rev. 1, 10- 01-03)  A/B MACs (B) pay for the PC and TC of CPT codes 77300- 77334 and 77399 on the same basis as they pay for radiologic services generally.  For professional component billings in all settings, A/B MACs (B) presume that the radiologist participated in the provi sion of the service, e.g., reviewed/validated the physicists calculation.  CPT codes 77336 and 77370 are technical services only codes that are payable by A/B MACs (B) in settings in which only technical component is are payable.   80 - Supervision and Interpretation (S&I) Codes and Interventional Radiology (Rev. 1, 10- 01-03)  80.1 - Physician Presence  (Rev. 1, 10- 01-03)  Radiologic supervision and interpretation (S&I) codes are used to describe the personal supervision of the performance of the radiologic portion of a procedure by one or more physicians and the interpretation of the findings.  In order to bill for the supe rvision aspect of the procedure, the physician must be present during its performance.  This kind of personal supervision of the performance of the procedure is a service to an individual beneficiary and differs from the type of general supervision of the radiologic procedures performed in a hospital for which A/B MACs (A) pay the costs as physician services to the hospital.  The interpretation of the procedure may be performed later by another physician.  In situations in which a cardiologist, for example, bills for the supervision (the S) of the S&I code, and a radiologist bills for the interpretation (the I ) of the code, both physicians should use a  -52 modifier indicating a reduced service, e.g., only one of supervision and/or interpretation.  Payment for the fragmented S&I code is no more than if a single physician furnished both aspects of the procedur e.  80.2 - Multiple Procedure Reduction  (Rev. 1, 10- 01-03)  A/B MACs (B) make no multiple procedure reductions in the S&I or primary non-radiologic codes in these types of procedures, or in any procedure codes for which the descriptor and RVUs reflect a multiple service reduction.  For additional procedure codes that do not reflect such a reduction, A/B MACs (B) apply the multiple proce dure reductions.   90 - Services of Portable X -Ray Suppliers  (Rev. 1, 10- 01-03)  Services furnished by portable x- ray suppliers may have as many as four components. A/B MACs (B) must follow the following rules.   90.1 - Professional Component  (Rev. 1, 10- 01-03)  Pay the PC of radiologic services furnished by portable x- ray suppliers on the same basis as other physician fee schedule services.   90.2 - Technical Component  (Rev. 1, 10- 01-03)  Pay the TC of radiology services furnished by portable x- ray suppliers under the fee schedule on the same basis as TC services generally.   90.3 - Transportation Component (HCPCS Codes R0070 - R0076)  (Rev. 3387, Issued: 10- 30-15, Effective: 01 -01-16, Implementation: 01- 01-16)  This component represents the transportation of the equipment to the patient.  Establish local RVUs for the transportation R codes based on Medicare Administrative Contractor (MAC) knowledge of the nature of the service furnished.  The MACs shall allow onl y a single transportation payment for each trip the portable x- ray supplier makes to a particular location.  When more than one patient is x- rayed at the same location, e.g., a nursing home, prorate the single fee schedule transportation payment among all patients (Medicare Parts A and B, and non- Medicare) receiving the portable x- ray services during that trip, regardless of their insurance status.  For example, for portable x- ray services furnished at a Skilled Nursing Facility (SNF), the transportation fe e should be allocated among all patients receiving portable x- ray services at the same location in a single trip irrespective of whether the patient is in a Part A stay, a Part B patient, or not a Medicare beneficiary at all.  If the patient is in a Part A SNF stay, the transpo rtation and set up costs are subject to consolidated billing and not separately billable to Medicare Part B.  For a privately insured patient, it would be the responsibility of that patients insurer.  For a Medicare Part B patient, payment would be made u nder Part B for the share of the transportation fee attributable to that patient.   R0075 must be billed in conjunction with the radiology codes and only when the x- ray equipment used was actually transported to the location where the x -ray was taken.  R0075 would not apply to the x- ray equipment stored in the location where the x- ray was  done (e.g., a nursing home) for use as needed.   Below are the definitions for each modifier that must be reported with R0075.  Only one of these five modifiers shall be reported with R0075.  NOTE : If only one patient is served, R0070 should be reported with no modifier since the descriptor for this code reflects only one patient seen.   UN -  Two patients served UP - Three patients served  UQ -  Four patients served  UR -  Five Patients served  US - Six or more patients served   Payment for the above modifiers must be consistent with the definition of the modifiers.  Therefore, for R0075 reported with modifiers, - UN, - UP, - UQ, and UR, the total payment for the service shall be divided by 2, 3, 4, and 5 respectively.  For modifier  US, the total payment for the service shall be divided by 6 regardless of the number of patients served.  For example, if 8 patients were served, R0075 would be reported with modifier US and the total payment for this service would be divided by 6.