2025 CPT code 79999
(Active) Effective Date: N/A Revision Date: N/A Radiology - Unlisted Procedure Radiology Procedures > Nuclear Medicine Procedures Feed
This code reports a radiopharmaceutical therapy procedure without a specific CPT code.
Modifiers may be applicable depending on the specific circumstances of the procedure. Consult the CPT manual and payer guidelines for appropriate modifier usage.
Medical necessity must be clearly established through documentation demonstrating that the radiopharmaceutical therapy was appropriate and necessary for the patient's diagnosis and treatment. This may involve demonstrating the failure of alternative treatment options or the unique clinical characteristics necessitating this specific approach.
The physician or qualified healthcare professional performing the radiopharmaceutical therapy procedure and providing all necessary documentation for billing.
- Radiology Procedures > Nuclear Medicine Procedures
- Radiology Procedures > Nuclear Medicine Procedures
In simple words: This code is for a type of radiation treatment using special medicine that doesn't have its own specific billing code.Doctors use this code when the treatment doesn't fit any of the other codes and they need to explain the treatment in detail to the insurance company.
CPT code 79999, "Radiopharmaceutical therapy, unlisted procedure," is used to bill for radiopharmaceutical therapy procedures not otherwise specified by a standard and active CPT code.This code should only be used when no other CPT code accurately reflects the procedure performed.Appropriate supporting documentation, including a detailed description of the procedure, justification for using an unlisted code, and comparison to similar coded procedures, must accompany the claim.
Example 1: A patient with metastatic bone cancer receives a targeted radiopharmaceutical therapy not yet assigned a specific CPT code. The physician uses 79999 and submits detailed documentation outlining the radiopharmaceutical used, the treatment procedure, and the patient's response., A patient with neuroendocrine tumors undergoes a novel radiopharmaceutical therapy guided by PET/CT imaging.The physician uses 79999 and includes documentation comparing the service to existing, similar coded procedures, demonstrating the unique aspects and justifying the charge., A patient with lymphoma is treated with an investigational radiopharmaceutical therapy still undergoing clinical trials.The physician utilizes 79999, providing comprehensive documentation including the research protocol, details of the treatment, and the rationale for its medical necessity.
* Detailed description of the radiopharmaceutical therapy procedure performed.* Justification for using unlisted code 79999 (explanation of why no other code accurately represents the service).* Comparison to similar, coded procedures to support the billed amount.* Operative notes, imaging reports, and other relevant medical records.* Information on the radiopharmaceutical used (including dosage and administration method).* Time spent performing the procedure.
** Always consult payer-specific guidelines for billing unlisted procedures, as policies and requirements may vary.Accurate and comprehensive documentation is critical for successful reimbursement.
- Revenue Code: P7A (ONCOLOGY - RADIATION THERAPY)
- RVU: RVUs are not assigned to unlisted codes like 79999. Reimbursement is determined on a case-by-case basis by the payer, based on submitted documentation.
- Global Days: Not applicable. Global surgical periods do not apply to unlisted procedures.
- Payment Status: Active, but reimbursement varies by payer and requires detailed supporting documentation.
- Modifier TC rule: The TC modifier (technical component) generally does not apply to this code, as it represents a professional service provided by a physician.
- Fee Schedule: Historical fee schedules are not directly applicable to unlisted codes. Reimbursement is determined individually by payers based on submitted documentation.
- Specialties:Nuclear Medicine, Oncology, Hematology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, Office