Procedure code 77014 is used daily during Radiation Therapy treatments. This code is defined by the AMA as; computed tomography guidance for placement of radiation therapy fields. This code is used every day of treatment, usually over the course of 6-8 weeks of therapy.

Definition: This code reports computed tomographic guidance for placement of radiation therapy fields. This is an important part of treatment planning which maps out the volume of the area to receive radiation treatment. The patient remains very still while CT scanning is applied. CT aims multiple, narrow beams of x-ray around a single rotational axis, taking a large series of two-dimensional images of the target structure from multiple angles. The computer can digitally reconstruct the data into a three dimensional image and produce thin, cross-sectional 2D or 3D images (slices) of the test object. Cross-sectional images are acquired for the entire treatment area. Both normal and abnormal tissue within the therapy field is defined and the treatment parameters are set for the best application of the radiation beam.

Since this code is defined as a CT scan, a number of major insurance companies process this procedure code as a daily diagnostic CT incorrectly and therefore, they will apply a Radiology copayment daily, which is substantially higher than the members’ daily Radiation therapy copayment. In some instances we have seen one insurer charge a daily copayment incorrectly of $225.00 per day for (34) consecutive days. This is in addition to the member’s coinsurance and deductible.

We have in all instances challenged these insurers to correct their inappropriately processed copayments, and have each overturned in the members favor and thereby increasing our providers reimbursement and decreased the patient responsibly portion substantially.

 

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