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30.2.9 Stereotactic Radiosurgery
The following procedure codes must be used to bill stereotactic radiosugery services (SRS):
Procedure code 61796 will not be reimbursed more than once per course of treatment. Procedure code 61796 will be denied if billed with the same date of service as procedure code 61798.
Procedure code 61797 must be billed with the same date of service as procedure code 61796 or 61798.
Procedure code 61799 must be billed with the same date of service as procedure code 61798.
Procedure codes 61797 and 61799 must not be billed more than once per lesion. Any combination of 61797 and 61799 may be billed up to four times for the entire course of treatment, regardless of the number of lesions treated.
Procedure code 61800 must be billed with the same date of service as procedure code 61796 or 61798.
Procedure code 63620 will not be reimbursed more than once per course of treatment.
Procedure code 63621 must be billed with the same date of service as procedure code 63620.
Procedure code 63620 will not be reimbursed more than two times for the entire course of treatment, regardless of the number of lesions treated.
Stereotactic radiosurgery services (procedure codes 63620 and 63621) will be denied if billed with the same date of service by the same provider as radiation treatment management procedure code 77435.
Authorization Requirements
Prior authorization requirements for SRS procedure codes may include, but are not limited to, diagnoses indicating one of the following medical conditions:
• Benign and malignant tumors of the central nervous system
•Vascular malformations
•Soft tissue tumors in the chest, abdomen, and pelvis
•Trigeminal neuralgia refractory to medical management
Other diagnoses may be considered after reviewing the documentation of medical necessity.
SRS is considered investigational and not a benefit of the CSHCN Services Program for all other indications including, but not limited to, epilepsy and chronic pain.
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