2025 CPT code 79403
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Radiology Procedures - Nuclear Medicine Procedures Radiology Feed
Radiopharmaceutical therapy using intravenously infused radiolabeled monoclonal antibodies.
Modifiers 26 (professional component) and TC (technical component) may apply, depending on the billing entity and payer's policy.Additional modifiers may apply depending on the specific circumstances of the procedure, such as those related to the location of service or the type of facility. Always refer to the specific payer's rules.
Medical necessity for this procedure is determined based on the patient's diagnosis, the nature of the disease, and the expected benefit from the therapy.Documentation needs to show the targeted treatment is medically appropriate and likely to produce a meaningful therapeutic effect. Specific criteria for medical necessity will vary depending on the payer.
The clinical responsibility involves administering the radiolabeled monoclonal antibodies intravenously, monitoring the patient's response to the therapy, and providing appropriate follow-up care. This typically involves a nuclear medicine physician or a physician specializing in the relevant area of oncology.
In simple words: This medical code describes a treatment where the doctor gives the patient medicine containing a small amount of radioactivity through an IV. This special medicine targets and kills cancer cells.
This CPT code, 79403, represents radiopharmaceutical therapy involving the intravenous infusion of radiolabeled monoclonal antibodies.The procedure targets specific cellular antigens, aiming to destroy tumor cells. This is a nuclear medicine therapy, utilizing radioactive materials (radiopharmaceuticals) to treat conditions such as cancer.The code does not include the cost of the radiopharmaceutical itself; that must be billed separately. Pre-treatment imaging should be reported using codes 78802 or 78804.This procedure should not be reported with code 79101.
Example 1: A patient with lymphoma receives an intravenous infusion of radiolabeled monoclonal antibodies targeting CD20 antigens, a treatment guided by imaging studies (codes 78802 or 78804)., A patient with thyroid cancer undergoes radioiodine (I-131) therapy. The administration of the radiopharmaceutical is billed separately from this code, which covers the professional component of the treatment and post-treatment monitoring., A patient with metastatic breast cancer receives a course of radioimmunotherapy with radiolabeled monoclonal antibodies targeting HER2 receptors, with regular blood tests and imaging follow-up to monitor for adverse effects and treatment efficacy.
* Detailed patient history and physical examination notes.* Results of pre-treatment imaging (if applicable), including codes 78802 or 78804.* Type and dosage of radiolabeled monoclonal antibodies administered.* Infusion procedure notes documenting the administration process.* Post-treatment monitoring and follow-up notes detailing the patient's response and any adverse effects.* Justification for the use of the radiopharmaceutical therapy based on medical necessity.
** Always refer to the most current CPT codebook and payer guidelines for the most accurate coding and reimbursement information. This information is for guidance only and should not be considered exhaustive or a substitute for professional medical billing expertise.
- Revenue Code: I1E (STANDARD IMAGING - NUCLEAR MEDICINE)
- RVU: The RVUs for this code will vary depending on the geographic location and payer.Consult the appropriate fee schedule for the specific RVU values.
- Global Days: Unknown.The global period for this procedure is not specified in the provided data.Consult payer guidelines.
- Payment Status: Active
- Modifier TC rule: Modifier TC may be applicable if only the technical component of the service is reported.This is subject to payer specific rules, and hospitals may not need to append the TC modifier.
- Fee Schedule: The historical fee schedule information for this code is not readily available in the provided context. Consult specific payer fee schedules and historical records for accurate data.
- Specialties:Nuclear Medicine, Oncology, Hematology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center