Clarification on the Proper Reporting of Radiation Treatment CPT Code 77427
National Government Services would like to advise providers that bill CPT code 77427, Radiation treatment management, five treatments, of the proper way to report this code.
Radiation treatment management represents a physician’s professional services. Reimbursement of one unit will represent consecutive five fractions or treatment sessions regardless of the number of days during which these treatments are administered.
CMS requires that physicians must indicate the number of radiation treatments on each claim when seeking reimbursement for weekly radiation therapy management as follows:
- Each unit of service (five sessions) of radiation therapy management service should be billed on a separate claim line.
- The from‐date should be the first date of each treatment period (five sessions), and the to‐date should be the date of the fifth or last session (fraction).
- If there are only three or four treatment sessions (fractions) to be billed for the entire treatment course, or for the last time period (week) at the completion of the entire course of therapy, then these may still be billed using the 77427 with units of service equal to one (1).
- If there are only one or two treatment sessions (fractions) left to be billed for that last time period (week) at the completion of the entire course of therapy, then these should not be billed, and are included as bundled into the previous week or period of therapy.
- Payment should only be made after the fifth treatment has been delivered, not before.
- Radiation therapy management must be submitted in five-session increments. Bill one (1) unit in Item 24G. The number of fractions may be indicated in Item 19 of the CMS-1500 claim form or the electronic equivalent, to expedite adjudication or claims processing.
- If more than one fraction is performed on the same date of service (i.e., AM and PM), providers may place descriptive information in Item 19 or the electronic equivalent to explain, such as “AM and PM.”
- Do not report CPT code 77427 for a ʺweekʺ of one to two fractions at the end of the therapy course.
- In the event that the five fractions occur in two different calendar months or years, the billing “from and to” dates should reflect the month in which the most fractions were performed.
- Example: Two fractions were performed on 1/30/2023 and 1/31/2023, and three fractions were performed on 2/1/2023, 2/2/2023 and 2/3/2023; the claim would be billed with a “from date” of 2/1/2023 and “to date” of 2/3/2023.
- Please note: Claims submitted with “from and to” dates spanning two different calendar months or years on the same line of service, will be denied.
CPT code 77431, Radiation therapy management with complete course of therapy consisting of one or two fractions only. Report this code to indicate when the complete course of treatment consists of one or two fractions and 77427 when at least three fractions are performed.
If either the “from” or “to” dates are missing, or if the units of service are greater than “1,” the claim will be returned as a billing error.
Related Content
Reviewed 10/12/2023