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39.3.10 Radiation Treatment Centers/Outpatient Facilities
Radiation treatment centers and outpatient hospitals will be reimbursed only for the technical component for services rendered in POS 5 for the following services:
The following clinical brachytherapy services procedure codes 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.
The following services will be allowed once per day, unless an appeal is submitted with documentation that supports the need for the service to be provided more than once:
• 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.
•Radioisotope therapy.
A consultation on the same day as clinical treatment planning and clinical brachytherapy is included in the therapeutic radiology procedure.
Laboratory and diagnostic radiologic services provided in an office (POS 1) will be reimbursed to physicians as a total component. Radiation treatment centers will also be reimbursed for the total component for these services in POS 5. Injectable medications given during the course of therapy in any setting will be reimbursed separately.
Normal follow-up care by the same physician on the day of any therapeutic radiology service will be denied. Medical services within program limitations may be paid on appeal when documentation supports the medical necessity of the visit due to services unrelated to the radiation treatment or radiation treatment complication.
Procedure code 2-19298 is a benefit of the Texas Medicaid Program.
No separate payment will be made for any of the following procedure codes provided on the same day as radiation therapy by the same provider:
No separate payment will be made for established office or outpatient visits within 90 days after radiation treatment by the same provider.
High energy neutron beam radiation therapy (procedure codes T-77422 and T-77423) are only payable for diagnosis codes 1420, 1421, 1422, 1428, and 1429.
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