2025 CPT code 79005
(Active) Effective Date: N/A Therapeutic Nuclear Medicine Procedures - Nuclear Medicine Radiology Feed
Radiopharmaceutical therapy, by oral administration.
Modifiers 26 (Professional Component), 52 (Reduced Services), 76 (Repeat Procedure or Service), 77 (Repeat Procedure by Another Physician), 79 (Unrelated Procedure or Service), 80 (Assistant Surgeon), 81 (Minimum Assistant Surgeon), 82 (Assistant Surgeon - Qualified Resident Not Available), 99 (Multiple Modifiers), and TC (Technical Component) may be applicable depending on the specific circumstances of the service.
Medical necessity must be established by demonstrating that the oral administration of a radiopharmaceutical is the appropriate treatment for the patient's specific condition. This may involve documentation of prior treatment failures or contraindications to alternative therapies.
Nuclear medicine specialists or other qualified healthcare professionals administer the radiopharmaceutical orally. They are responsible for the safe handling and administration of the radioactive material, as well as monitoring the patient for any adverse reactions.
In simple words: This procedure involves swallowing a radioactive substance in capsule or liquid form to treat conditions like thyroid disorders or certain types of cancer. The substance emits radiation that travels a short distance, targeting the affected area while minimizing damage to healthy tissues.
This code represents the oral administration of a radiopharmaceutical substance for therapeutic purposes, commonly used in treating certain cancers and other medical conditions. This method involves using radioactive materials, known as radiopharmaceuticals, to target specific areas in the body.
Example 1: A patient with hyperthyroidism receives radioactive iodine orally to destroy overactive thyroid cells., A patient with thyroid cancer is given radioactive iodine to target and eliminate cancerous thyroid tissue after surgery., A patient with bone pain due to cancer metastasis receives an oral radiopharmaceutical to alleviate pain.
Documentation should include the type and dose of radiopharmaceutical administered, the route of administration (oral), the medical condition being treated, and any pre- and post-administration instructions given to the patient. Additionally, any relevant imaging studies or lab results should be documented.
** The supply of the radiopharmaceutical may be reported separately. If only the physician's interpretation is being reported, modifier 26 should be appended.If reporting only the technical component, modifier TC should be used. For global services, no modifier is needed.
- Revenue Code: P6D
- Payment Status: Active
- Modifier TC rule: Modifier TC is applicable when billing for the technical component only, as might be the case with portable X-ray suppliers.
- Specialties:Nuclear medicine, radiation oncology, endocrinology
- Place of Service:Office, Hospital Inpatient/Outpatient, Independent Clinic, and other facilities where nuclear medicine procedures are performed.