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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.60 Radiation Therapy : 9.2.60.1 Brachytherapy

9.2.60.1
9.2.60.1.1
Prior authorization is not required for brachytherapy.
9.2.60.1.2
Clinical brachytherapy services include admission to the hospital and daily care. Initial and subsequent hospital care will be denied as part of another service when billed with the same date of service as clinical brachytherapy services.
An office visit will be denied as part of another service when billed with the same date of service by the same provider as clinical treatment planning and clinical brachytherapy.
Normal follow-up care by the same physician will be denied as part of another service when billed with the same dates of service as any therapeutic radiology service. Any other E/M office visit will be denied as part of another service when billed with the same date of service by the same provider as the radiation treatment or radiation treatment complication.
Providers may use modifier 25 to indicate that the additional visit was for a separate, distinct service unrelated to the radiation treatment or radiation treatment complication. Documentation that supports the provision of a significant, separately identifiable E/M service must be maintained in the client’s medical record and made available upon request.
Each service provided using procedure codes 77316, 77317, 77318, 77321 and 77470 are limited to once per two calendar months.
Documentation that supports the provision of special procedures must be maintained in the client’s medical record and made available upon request.

Texas Medicaid & Healthcare Partnership
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