2025 CPT code 77290
Effective Date: N/A Radiology Procedures > Radiation Oncology Treatment Feed
Therapeutic radiology simulation-aided field setting; complex.
Modifiers may be applicable to 77290 in certain situations. For instance, modifier 26 may be used to indicate that only the professional component of the service was provided. Modifier 52 might be used if the service was reduced for some reason.
Medical necessity for 77290 is established when the patient's condition requires a complex radiation treatment plan due to factors such as multiple treatment areas, challenging tumor locations or shapes, or the use of advanced treatment techniques. The documentation must clearly demonstrate why a simple or intermediate simulation would not be sufficient to achieve optimal treatment outcomes.
The physician's role in this complex simulation procedure is critical. It involves a high degree of planning and customization to ensure the radiation therapy effectively targets the tumor(s) while sparing healthy surrounding tissues. The process can become particularly challenging with three or more treatment areas or complex tumor shapes, requiring advanced techniques like complex blocking, custom shielding blocks, tangential ports, brachytherapy, and arc therapy.
In simple words: Before radiation therapy begins, doctors use special imaging and computer simulations to map out the exact location and size of the tumor. This detailed 3D map helps them plan the best way to deliver radiation, hitting the tumor accurately while minimizing harm to healthy tissues.This complex simulation process is used when there are multiple areas to treat or when special techniques are needed to target the tumor effectively.
This code represents a complex, simulation-aided field setting in therapeutic radiology. It involves intricate processes like determining the precise location and size of the tumor, calculating the necessary radiation dosage, and meticulously positioning radiation beams for optimal targeting. Advanced imaging techniques and computerized reconstructions help create a simulated field that accurately reflects the tumor's geometry within the body.This complex process often involves three or more treatment areas, and may utilize techniques such as tangential ports, rotation or arc therapy, complex blocking, custom shielding blocks, brachytherapy source verification, hyperthermia probe verification, and the use of contrast materials.
Example 1: A patient with three separate tumors requiring radiation therapy undergoes a complex simulation-aided field setting procedure to ensure precise targeting of each tumor., A patient with a complex tumor shape requiring arc therapy undergoes a complex simulation to determine the appropriate radiation beam angles and dosages., A patient receiving brachytherapy undergoes a complex simulation to verify the accurate placement of radioactive sources within the body.
Documentation for 77290 should include detailed records of the simulation process, including imaging data, target volumes, treatment planning parameters, and the rationale for using complex techniques. Any custom shielding blocks or other specialized devices used should also be documented. The number and location of treatment areas and the specific techniques employed (e.g., tangential ports, arc therapy) should be clearly specified. Physician notes should justify the medical necessity of the complex simulation.
- Revenue Code: P7A - ONCOLOGY - RADIATION THERAPY
- Specialties:Radiation Oncology
- Place of Service:Office, Outpatient Hospital, Freestanding Radiation Therapy Center