CPT code 77290, 77300, 77334, 61796, 77373, 77371 – SRS Body Radiation Therapy: Cranial Lesions

Procedure  Code        Long Descriptor

77371  –Radiation treatment delivery, stereotactic radiosurgery (srs), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source cobalt 60 based

77372 – Radiation treatment delivery, stereotactic radiosurgery (srs), complete course of treatment of cranial lesion(s) consisting of 1 session; linear accelerator based

77373 – Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions


77290 Therapeutic radiology simulation-aided field setting; complex

77295  Therapeutic radiology simulation-aided field setting; 3-dimensional

77300  Basic radiation dosimetry calculation, central axis depth dose calculation, tdf, nsd, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician

77334  Treatment devices, design and construction; complex (irregular blocks, special shields, compensators, wedges, molds or casts)


Stereotactic Body Radiation Therapy (SBRT) (not for cranial lesions)


Background

SBRT is a treatment that couples a high degree of anatomic targeting accuracy and reproducibility with very high doses of extremely precise, externally generated, ionizing radiation, thereby maximizing the cell-killing effect on the target(s) while minimizing radiation-related injury in adjacent normal tissues. SBRT is used to treat extracranial sites as opposed to stereotactic radiosurgery (SRS), which is used to treat intra-cranial and spinal targets.

The adjective “stereotactic” describes a procedure during which a target lesion is localized relative to a known three dimensional reference system that allows for a high degree of anatomic accuracy and precision. Examples of devices used in SBRT for stereotactic guidance may include a body frame with external reference markers in which a patient is positioned securely, a system of implanted fiducial markers that can be visualized with low energy (kV) x-rays, and CT-imaging-based systems used to confirm the location of a tumor immediately prior to treatment.

Treatment of extra-cranial sites requires accounting for internal organ motion as well as for patient motion. Thus, reliable immobilization or repositioning systems must often be combined with devices capable of decreasing organ motion or accounting for organ motion e.g. respiratory gating. Additionally, all SBRT is performed with at least one form of image guidance to confirm proper patient positioning and tumor localization prior to delivery of each fraction.

SBRT may be delivered in one to five sessions (fractions). Since the goal of SBRT is to maximize the potency of the radiotherapy by completing an entire course of treatment within an extremely accelerated time frame, any course of radiation treatment extending beyond five fractions is not considered SBRT and is not to be billed using these codes. SBRT is meant to represent a complete course of treatment and not to be used as a boost following a conventionally fractionated course of treatment.

SBRT addresses only the CPT codes for SBRT treatment management (77435), and SBRT treatment delivery (77373, G0339, and G0340).

• Position stabilization (attachment of a frame or frameless).
• Imaging for localization (Computed Tomography (CT), Magnetic Resonance Imaging (MRI), angiography, Positron Emission Tomography (PET), etc.).
• Computer-assisted tumor localization (i.e., image guidance).
• Treatment planning – number of isocenters, number, placement and length of arcs or angles, beam size and weight, etc.
• Isodose distributions, dosage prescription and calculation.
• Setup and accuracy verification testing.
• Simulation of prescribed arcs or fixed portals.
• Radiation treatment delivery.

• Primary central nervous system malignancies, generally under 5 cm.
• Primary and secondary tumors involving the brain or spine parenchyma, meninges/dura or immediately adjacent boney structures.
• Benign brain tumors and spinal tumors such as meningiomas, acoustic neuromas, pituitary adenomas and pineal cytomas.
• Cranial arteriovenous malformations and hemangiomas.
• Other cranial non-neoplastic conditions for which it has been proven effective, e.g., movement disorders such as Parkinson’s disease, essential tremor and other disabling tremor that are refractory to conventional therapy, such as severe, sustained trigeminal neuralgia not responsive to other modalities.
• As a boost treatment for larger cranial or spinal lesions that have been treated initially with external beam radiation therapy or surgery (i.e., grade III and IV gliomas, oligodendrogliomas, sarcomas, chondrosarcomas, chordomas and nasopharyngeal or paranasal sinus malignancies).
• Metastatic brain or spine lesions, generally limited in number, with stable systemic disease, Karnofsky Performance Status 70 or greater (or expected to return to 70 or greater with treatment) and otherwise reasonable survival expectations.
• Relapse in a previously irradiated cranial or spinal field where the additional stereotactic precision is required to avoid unacceptable vital tissue radiation.

• Medicare would not expect to provide payment for the following:
  • Treatment for anything other than a severe symptom or serious threat to life or critical functions, not responsive or reasonably amenable to another therapy.
  • Treatment unlikely to result in functional improvement or clinically meaningful disease stabilization, not otherwise achievable.
  • Patients with wide-spread cerebral or extra-cranial metastases.
  • Patients with poor performance status (Karnofsky Performance Status less than 40), – see Karnofsky Performance Status below.
  • A claim for stereotactic cingulotomy as a means of psychotherapy, considered investigational, per Medicare National Coverage Determinations (NCD) Manual, IOM Pub. 100-03, Chapter 1, Part 2, Section 160.4 (formerly CIM 35-84).

• Safe and effective.
• Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
• Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
  • Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
  • Furnished in a setting appropriate to the patient’s medical needs and condition.
  • Ordered and furnished by qualified personnel.
  • One that meets, but does not exceed, the patient’s medical need.
  • At least as beneficial as an existing and available medically appropriate alternative.