2025 CPT code 77412
(Active) Effective Date: N/A Revision Date: N/A Radiology - Radiation Treatment Delivery Radiation Oncology Treatment Feed
This code represents the technical component of complex radiation treatment delivery using ≥ 1 MeV energy, involving three or more treatment areas, specialized blocking, varied ports/angles, and beam modifications.
Modifiers may apply depending on the specific circumstances of the treatment, such as 59 (distinct procedural service) or other modifiers as dictated by payer requirements or individual clinical scenarios. Consult the most updated payer guidelines.
Medical necessity for 77412 is established by the presence of a malignant neoplasm requiring radiation therapy and the documented clinical need for complex treatment techniques due to the location, size, and extent of the tumor(s) and proximity to critical organs at risk. This necessitates multiple treatment fields, custom blocking, wedges, compensators, and/or specialized beam arrangements to achieve adequate tumor control while minimizing harm to healthy tissues.
The clinical responsibility for this code lies primarily with the radiation therapist or technician who operates the radiation equipment and delivers the treatment.The radiation oncologist is responsible for the overall treatment plan, medical decision-making, and supervision of the treatment delivery process.The physician bills separately for their services.
In simple words: This code is for the technical part of giving a complex type of radiation treatment. This treatment uses a high-energy beam to target cancer. The treatment is complex because it involves many different areas of the body, specialized tools to protect healthy tissue, and adjustments to the radiation beam itself. The doctor bills separately for their part in planning and supervising the treatment.
CPT code 77412 reports the technical component of complex radiation treatment delivery with ≥ 1 MeV energy.The treatment includes three or more distinct treatment areas, customized blocking, multiple ports or angled delivery methods, and adjustments to the radiation beam's energy or characteristics. This code encompasses the technical aspects of delivering the radiation; physician professional services are billed separately.The technical component involves setting up and operating the radiation equipment, precisely targeting the radiation beam, and ensuring patient safety during treatment.It does not include the professional component of treatment planning or medical decision-making.
Example 1: A patient with metastatic lung cancer requiring radiation to three separate lung lesions, each requiring custom blocking to protect the heart and major vessels.The treatment will involve multiple beam angles and energies. , A patient diagnosed with locally advanced head and neck cancer who needs radiation to multiple lymph nodes in the neck, along with radiation to the primary tumor. Specialized shielding (custom blocks) is necessary to protect salivary glands and spinal cord.The treatment may involve complex techniques such as intensity-modulated radiation therapy (IMRT)., A patient with pelvic cancer requiring radiation to both the primary tumor and regional lymph nodes. The complex geometry requires the use of wedges and other compensators to optimize dose distribution.
Comprehensive documentation is needed, including the treatment plan specifying the number of treatment areas, type of radiation, energy levels used, and the justification for the complexity of the treatment. This should include imaging studies (CT, MRI, PET) defining target volumes and organs at risk.Detailed treatment records indicating specific beam angles, field sizes, shielding used (blocks, wedges, compensators), and the total dose delivered to each treatment area.Progress notes should document patient tolerance to treatment and any adverse events.
** This code is used for the technical component only.The professional component (physician services) is reported separately using appropriate codes (e.g., for image guidance, treatment planning, etc.).Ensure proper coding of all components of the treatment to avoid claims denials.
- Payment Status: Active
- Modifier TC rule: The TC modifier applies to this code as it represents the technical component of the service, which is typically billed by the facility.
- Specialties:Radiation Oncology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center