2025 CPT code 77470
Effective Date: N/A Revision Date: N/A Radiology - Radiation Oncology Feed
Special radiation treatment procedure (e.g., total body irradiation, hemibody radiation, per oral or endocavitary irradiation).
Modifiers 26 (professional component) and TC (technical component) may be applicable if reporting only one component of the service. Payer policies regarding modifier TC for hospitals should be consulted.
Medical necessity for 77470 is established by the complexity of the radiation treatment exceeding typical cases, such as total body irradiation, specialized techniques, or combined modalities, requiring additional physician work and resources. Clear documentation should justify the need for the special procedure.
The radiation oncologist is responsible for the additional planning, execution, and management of these special radiation treatment procedures, requiring expertise in advanced radiation physics, medical imaging, and precise dose calculations.
In simple words: This code represents the extra effort involved in complex radiation treatments that need special planning and resources beyond typical radiation therapy, such as treating the whole body or specific areas with specialized techniques.
This code encompasses additional physician work and resources for complex radiation therapy procedures not otherwise specified, including total body irradiation, hemibody radiation, and per oral or endocavitary irradiation. It may also be used for extra effort with brachytherapy or concurrent chemotherapy with external beam radiation therapy. It is reported once during a treatment course, alongside primary treatment management codes. It covers procedures like hyperfractionation, brachytherapy, hyperthermia, planned combination with chemotherapy, stereotactic radiosurgery, intra-operative radiation therapy, hemibody irradiation, intracavitary cone use, radiation response modifiers, heavy particles, 3-D CRT, IMRT, and other time-consuming treatment plans.
Example 1: A patient receives total body irradiation prior to a bone marrow transplant, requiring meticulous planning and monitoring, justifying the use of 77470., A patient with a rectal tumor undergoes endocavitary irradiation, a complex procedure demanding precise delivery and management, making 77470 applicable., A patient receives external beam radiation therapy concurrently with chemotherapy, adding complexity to the treatment plan and management, thus 77470 is reported.
Documentation must support the medical necessity of the special procedure, detailing the complexity and additional resources utilized beyond standard radiation therapy, as well as the specific technique employed (e.g., total body irradiation, hemibody radiation, endocavitary).
- Specialties:Radiation Oncology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, Freestanding Radiation Therapy Center.