TMPPM 2008 > Texas Medicaid Services > Hospital (Medical/Surgical Acute Care Facility) > Outpatient

25.3.3.25 Hospital Radiation Therapy Services

Outpatient radiation therapy is limited to a maximum of five facility services every seven days beginning with the first date of service.

Take-home drugs given during the course of therapy can be reimbursed separately through the Vendor Drug Program.

Freestanding radiation therapy facilities (specialty 98) and outpatient hospitals are reimbursed only for the technical component (TOS T) for services rendered in POS 5 for the services listed in the following procedure code tables.

The following radiation therapy services provided in an outpatient setting are allowed only once per day unless documentation of medical necessity supports the need for repeated services: therapeutic radiation treatment planning, therapeutic radiology simulation-aided field setting, teletherapy, brachytherapy isodose calculation, treatment devices, proton beam delivery/treatment, intracavity radiation source application, interstitial radiation source application, remote afterloading high intensity brachytherapy, radiation treatment delivery, localization, and radioisotope therapy.

Clinical Treatment Planning

Refer to: "Physician" for further radiation therapy guidelines.

Medical Radiation Physics, Dosimetry, Treatment Devices, and Special Services

Clinical Brachytherapy

Radiation Treatment Delivery/Port Films

Contrast Materials/Radiopharmaceuticals

Reimbursement for radiological procedures, such as MRI or CT, with descriptions that specify with contrast, include payment for high osmolar, LOCM and paramagnetic contrast materials. These contrast materials will not be reimbursed separately.

Radiopharmaceuticals, when used for therapeutic treatment, may be considered for separate reimbursement.

The following procedure codes may be billed for therapeutic radiopharmaceuticals:

The following services are not benefits of the Texas Medicaid Program:

Radiation therapy services will be allowed once per day, unless documentation submitted with an appeal supports the need for the service to be provided more than once.

Clinical brachytherapy services include admission to the hospital and daily care. Initial and subsequent hospital care will be denied on the same day that clinical brachytherapy services are billed.

Texas Medicaid Program benefits include payment for the technical portion of radiation therapy services provided in an inpatient setting. Covered services include clinical treatment planning and management and clinical brachytherapy. Hospitals use revenue code B-333, Radiation therapy, on the UB-04 CMS-1450 claim form when submitting charges for these services.