Can we bill out CBCT when we do IMRT?

[XRT_doc]

Can we bill CBCT (77014) when we do IMRT? I know technical doesn't allow it but what about professional?

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[scarbrtj]

see here

 

[BobbyHeenan]

As scarb posted, if billing pro fees in the hospital setting most billing experts (and I believe CMS/Medicare too) say you should bill it.

However, now two insurers we work with are just flat out refusing to pay for it.

 

[RadOncMegatron]

As scarb posted, if billing pro fees in the hospital setting most billing experts (and I believe CMS/Medicare too) say you should bill it.

However, now two insurers we work with are just flat out refusing to pay for it.

Disgusting

 

[Reaganite]

As scarb posted, if billing pro fees in the hospital setting most billing experts (and I believe CMS/Medicare too) say you should bill it.

However, now two insurers we work with are just flat out refusing to pay for it.

yup, seeing this with cigna and aetna I think. (Don't quote me but also just started noticing it was 2 insurers).

 

[BobbyHeenan]

yup, seeing this with cigna and aetna I think. (Don't quote me but also just started noticing it was 2 insurers).

Aetna is one, I can't recall the other off the top of my head.

I may be wrong here, but our Cigna uses evicore, and evicore billing guidelines support billing for the CBCT. Evicore, ASTRO, and Bogardus' company all say to bill it...and we've let aetna know this, but they don't give a f*ck, they're not paying for it they say.

ASTRO has battled aetna on this for a couple of years now and I don't think have made any progress.

 

[Mandelin Rain]

Yes, the arbitrary "We're just not paying you because we feel like it" for IGRT has popped it's head up at times the past several years. I'm not sure how it's remotely legal, but here we are.

 

[scarbrtj]

Aetna is one, I can't recall the other off the top of my head.

I may be wrong here, but our Cigna uses evicore, and evicore billing guidelines support billing for the CBCT. Evicore, ASTRO, and Bogardus' company all say to bill it...and we've let aetna know this, but they don't give a f*ck, they're not paying for it they say.

ASTRO has battled aetna on this for a couple of years now and I don't think have made any progress.

While we can blame ASTRO for not doing more (if you're battling fraction numbers or IMRT or UroRads or championing protons it only leaves so much energy for other stuff), or Aetna or other ins. co's for not paying, I mostly blame CMS for sowing the seeds of confusion in this arena. (We have, like, what, about 50 CPT codes we use for most things most of the time? And I bet we have changed and shifted and maneuvered a good third of those around the last 10-plus years.) It goes back to this monetarily inexplicable b*ner CMS has for rad onc. Maybe the APM and its recent limp dishrag droppage signals CMS' realization there are bigger fish to fry?

 

[BobbyHeenan]

While we can blame ASTRO for not doing more (if you're battling fraction numbers or IMRT or UroRads or championing protons it only leaves so much energy for other stuff), or Aetna or other ins. co's for not paying, I mostly blame CMS for sowing the seeds of confusion in this arena. (We have, like, what, about 50 CPT codes we use for most things most of the time? And I bet we have changed and shifted and maneuvered a good third of those around the last 10-plus years.) It goes back to this monetarily inexplicable b*ner CMS has for rad onc. Maybe the APM and its recent limp dishrag droppage signals CMS' realization there are bigger fish to fry?

It's definitely a little confusing on the surface that 77014 exists for not only a complex CT simulation, but also a CBCT...but anyone familiar with radiation can understand they are different procedures....Yes, the 77014 for CT was bundled with IMRT (or some may argue 3D according to AIG), but the 77014 for CBCT was never bundled.

So it's not that they don't understand, it's that they don't want to understand (or pay). You know this, I know.