The new radiation therapy G-codes for 2015

Radiation Oncology

Effective January 1, 2015 AMA released G codes for all existing Radiation Oncology Codes.

On August 28, 2014, the American Medical Association (AMA) released 2015 CPT code changes,
including certain changes relevant to radiation oncology. 

Due to a new policy for establishing valuations for newly created and revised CPT codes included in the CY 2015 Physician Fee Schedule Final Rule, however, the Centers for Medicare & Medicaid Services will delay the implementation of code sets and values for other radiation oncology procedures so they can be issued as proposals in the CY 2016 PFS Proposed Rule.  As a result, these radiation oncology procedures will have interim G-codes established for 2015 to allow practitioners to continue to report services to CMS in CY 2015 as they did in CY 2014 and for payments to be made in the same way. 

All payment policies applicable to the CY 2014 CPT codes will apply to the replacement G-codes.
Please note: It is important that non-federal payors adopt these G-codes for 2015 for physician office claims in order that providers in the non-facility setting may bill all carriers uniformly.

I. NEW RADIATION THERAPY CPT CODES AND VALUES ESTABLISHED FOR CY 2015

Three teletherapy CPT codes (77305, 77310, 77315) and three brachytherapy CPT codes (77326,
77327, 77328) have been deleted. 

The three deleted teletherapy isodose planning CPT codes have been replaced with two new CPT codes listed below that will be used to report these services:

CPT 77306: Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of
interest), includes basic dosimetry calculation(s)

CPT 77307: Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use
of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry
calculation(s)

The three deleted brachytherapy isodose planning CPT codes have been replaced with three new CPT codes listed below that will be used to report these services:

CPT 77316: Brachytherapy isodose plan; simple (calculation made from 1 to 4 sources, or remote
after loading brachytherapy, 1 channel), includes basic dosimetry calculation(s) 

CPT 77317: Brachytherapy isodose plan; intermediate (calculations made from 5 to 10 sources, or
remote after loading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s) 

CPT 77318: Brachytherapy isodose plan; complex (calculations made from over 10 sources, or
remote after loading brachytherapy, over 12 channels), includes basic dosimetry calculation(s) 

II. NEW RADIATION THERAPY G-CODES AND VALUES ESTABLISHED FOR CY 2015

 CPT codes used to report conventional radiation therapy treatment delivery (77403, 77404, 77406, 77408, 77409, 77411, 77413, 77414, and 77416), intensity modulated radiation therapy (IMRT) treatment delivery (77418 and 0073T), and image guided radiation therapy (IGRT) codes (77421, 76950 and 0197T) have been deleted. 

CPT codes 77402, 77407 and 77412 have been revised. 

Please note, however, that image guided radiation therapy (IGRT) CPT code 77014 (Computed Tomography Guidance for Placement of Radiation Therapy Fields) remains unchanged.

New and revised CY 2015 CPT codes will not be recognized for these services by Medicare for CY 2015 and are denoted with an “I” (Not valid for Medicare purposes).  Instead, these radiation oncology procedures will have interim G-codes established for 2015 to allow practitioners to continue to report services to CMS in CY 2015 as they did in CY 2014 and for payments to be made in the same way. 

All payment policies applicable to the CY 2014 CPT codes will apply to the replacement G-codes.

The chart below lists the G-codes that CMS has created and the CY 2014 CPT codes that they are replacing for 2015.  CMS has maintained the inputs for these radiation therapy codes at the CY 2014 levels.  (Due to budget neutrality adjustments and other system-wide changes, relative value units (RVUs) may have changed.  RVUs for the new G-codes are available in Addendum B in the “Downloads” section of the CMS website.

Radiation Therapy G-Codes Replacing CY 2015 CPT Codes 2014 CPT CODES 2015 G - Codes CPT Description 76950 G6001 Ultrasonic guidance for placement of radiation therapy fields 77421 G6002 Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy  77402 G6003 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: up to 5MeV  77403 G6004 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 6-10 MeV  77404 G6005 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 11-19 MeV  77406 G6006 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 20 MeV or greater  77407 G6007 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks; up to 5MeV  77408 G6008 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks; 6-10 MeV  77409 G6009 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks; 11-19 MeV  77411 G6010 Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks; 20 MeV or greater  77412 G6011 Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5MeV  77413 G6012 Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 MeV  77414 G6013 Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 MeV 77416 G6014 Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 MeV or greater  77418 G6015 Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic MLC, per treatment session  0073T G6016 Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator, convergent beam modulated fields, per treatment  0197T G6017 Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (eg,3D positional tracking, gating, 3D surface tracking), each fraction of treatment