April 02, 2019

CMS Updates E/M Codes Involving Superficial Radiation Treatment

The Centers for Medicare and Medicaid Services (CMS) recently issued an MLN Matters article to reflect updates to Chapter 13 of the Medicare claims processing manual.

These revisions allow providers to bill Evaluation and Management (E/M) codes 99211, 99212 and 99213 for Levels I through III, when performed with superficial radiation treatment delivery (up to 200 kV), for the purpose of reporting physician work associated with:

  • Radiation therapy planning
  • Radiation treatment device construction
  • Radiation treatment management when performed on the same date of service as superficial radiation treatment delivery

CMS revised the Change Request 11137 to clarify that providers need to bill the 25 modifier when performing E/M services with CPT code 77401 (Radiation treatment delivery, superficial and/or ortho voltage, per day). Billing of these E/M codes with modifier 25 may be necessary if National Correct Coding Initiative (NCCI) edits apply.

We recommend you notify your billing staff of these revisions. Medicare Administrative Contractors (MACs) will not search their files for claims already paid or to retroactively pay claims. However, MACs will adjust affected claims brought to their attention. For more assistance, contact your MAC.