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25.3.4 Proton Beam Therapy
Physicians, radiation treatment centers, and outpatient facilities may be reimbursed for the total component for procedure codes 6-77520, 6-77522, 6-77523, and 6-77525.
Total components are allowed for facilities because the procedure itself would not be broken into technical and professional components.
Proton beam therapy must be prior authorized. Proton beam therapy is limited to the following diagnosis codes:
Other diagnoses may be considered after review of documentation of medical necessity along with a review of current literature supporting the requested therapy.
Physicians may also seek reimbursement for appropriate clinical treatment and management procedures when providing services in their offices.
Prior authorization is required for proton beam therapy (procedure codes 6-77520, 6-77522, 6-77523, and 6-77525).
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