Billing CPT 77387, which pertains to Intensity Modulated Radiation Therapy (IMRT) delivery, requires precise use of modifiers to distinguish between the professional and technical components of the service, especially in a hospital setting. This code encompasses the complex planning, daily localization, verification, and treatment delivery essential for precise radiation treatment.
Understanding CPT 77387
CPT code 77387 describes the delivery of IMRT, a highly advanced form of radiation therapy that uses sophisticated computer programs to deliver radiation doses tailored to the shape of a tumor. This precision helps to minimize radiation exposure to surrounding healthy tissues. The code typically covers the entire course of therapy, including treatment planning, daily image-guided localization, and setup of treatment devices.
Billing for Professional Services: The -26 Modifier
When a physician or other qualified healthcare professional provides the professional component of IMRT services in a hospital or facility setting, the CPT code 77387 should be appended with the -26 modifier.
- What it covers: This modifier signifies the physician's work, including supervision, interpretation of images for localization, treatment planning, and overall management of the patient's radiation therapy course.
- Who bills with -26: Typically, the radiation oncologist or a physician group will bill for their professional oversight and expertise using this modifier.
Example:
A radiation oncologist at a hospital reviews the daily image guidance, adjusts the treatment plan based on patient response, and ensures the accurate delivery of IMRT. Their services would be billed as 77387-26.
Billing for Technical Services: The -TC Modifier
For the technical component of IMRT delivery, particularly when rendered by a hospital or freestanding radiation oncology center, the CPT code 77387 is reported with the -TC modifier.
- What it covers: This component accounts for the facility's resources, including the use of highly specialized equipment (linear accelerator, imaging devices), staff time (radiation therapists, dosimetrists, physicists), supplies, and the physical space where the treatment is administered.
- Who bills with -TC: Hospitals frequently use CPT code 77387 to report this technical component, especially under the Hospital Outpatient Prospective Payment System (HOPPS).
Example:
A hospital provides the physical space, utilizes its linear accelerator, and employs the staff necessary to deliver the IMRT treatment. The hospital would bill for these facility services as 77387-TC.
Modifiers for CPT 77387 at a Glance
The following table summarizes the key modifiers used for billing CPT 77387:
| Modifier | Component Represented | Billing Entity/Context | Key Purpose |
|---|---|---|---|
| -26 | Professional | Physician, qualified healthcare professional in a facility | Covers physician's interpretation, supervision, and management of the IMRT service. |
| -TC | Technical | Hospital, freestanding facility | Covers the facility's equipment, supplies, technical staff, and overhead associated with IMRT delivery. |
Important Billing Considerations
- Separating Services: It is crucial to correctly separate the professional and technical components of IMRT to ensure accurate reimbursement and compliance with payer rules. Billing without appropriate modifiers can lead to claim denials.
- Image-Guided Radiation Therapy (IGRT): CPT code 77387 is often used in conjunction with or for services that incorporate Image-Guided Radiation Therapy (IGRT), which uses advanced imaging to guide and verify the daily positioning of the patient and the radiation beams.
- Payer Policies: Always consult specific payer guidelines (e.g., Medicare, commercial insurers) as policies regarding IMRT billing, including frequency and specific documentation requirements, can vary. Staying updated on these policies is vital for successful claims processing.
By accurately applying these modifiers, providers and facilities can ensure proper reimbursement for the sophisticated services involved in Intensity Modulated Radiation Therapy.
