2025 CPT code 77427
(Active) Effective Date: N/A Radiation Oncology - Radiation Oncology Treatment Management Radiology Feed
Radiation treatment management, five treatments.
Modifiers may be applicable in certain situations, such as reduced services (modifier 52) or discontinued procedures (modifier 53). Refer to current CPT guidelines for appropriate modifier usage.
Medical necessity for radiation treatment management must be established based on the patient's diagnosis, treatment plan, and clinical response. The documentation must support the need for ongoing management by the radiation oncologist.
The radiation oncologist is responsible for the patient's overall management during radiation therapy. This includes evaluating the patient's response to treatment, adjusting the treatment plan as needed, coordinating care, and reviewing imaging and lab results. The physician must have at least one face-to-face encounter with the patient for each reported 77427.
In simple words: This code covers the doctor's supervision of your radiation therapy over five sessions. It includes checking your progress, how you're handling the treatment, and adjusting the plan as needed.The doctor reviews images, dosage, and your overall health during this time.
This code encompasses the physician's management of radiation therapy treatments, including a minimum of one patient examination for medical evaluation and management for each five fractions of treatment.Services included are review of port images, dosimetry, dose delivery, treatment parameters, patient treatment set-up, assessment of patient's response to treatment, coordination of care and treatment, and review of imaging and/or lab test results with documentation.
Example 1: A patient receives external beam radiation therapy for prostate cancer, undergoing five fractions of treatment over a week. The radiation oncologist reviews port films, dosimetry, and examines the patient during this period, thus 77427 is reported., A patient with lung cancer receives a course of radiation therapy consisting of 23 fractions. The radiation oncologist sees the patient for evaluation and management during the course. Code 77427 is reported four times (for the first 20 fractions). Since there are three remaining fractions at the end of the course, code 77427 can also be reported a fifth time to account for these fractions., A patient receives intensity-modulated radiation therapy (IMRT) for breast cancer, and the physician manages the treatment over five sessions, reviewing images and evaluating the patient's response. 77427 is reported.
Documentation should include the number of fractions delivered, dates of service, review of port images/imaging, dosimetry review, details of patient examination, assessment of treatment response, care coordination notes, and review of imaging/lab results.Medical necessity for the radiation treatment should also be documented.
** Medicare payment policy considers the professional interpretation of port images as part of 77427. However, the technical component may be reported separately using 77417 in non-facility or physician office/freestanding settings.For IGRT guidance, refer to ASTRO guidelines. This information is current as of 2024-11-30.
- Payment Status: Active
- Specialties:Radiation Oncology
- Place of Service:Office, Outpatient Hospital, Freestanding Radiation Therapy Center