SpaceOAR Gets a Code

SpaceOAR Gets a Code

CPT® 2018 introduces a new Category I code, 55874 Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed to describe the supply and placement of a temporary, biodegradeable implant, marketed as the SpaceOAR System, that is used to reduce rectal injury in men receiving prostate cancer radiation therapy (RT). Code 55874 replaces category III code 0438T.

The AMA’s CPT Changes 2017: An Insider’s Guide explains:

Although higher doses of radiation therapy may be used for treatment of prostate tissue to improve biochemical disease-free survival, the adverse effect is that an exposed rectum also receives radiation, increasing the risk of toxicity to the rectum and gastrointestinal tract.

The SpaceOAR implant acts as a spacer, pushing the rectum away from prostate; thereby, reducing the amount of incidental radiation the rectum is exposed to during RT for prostate cancer.

The implant is placed via needle, and placement includes imaging guidance. Per CPT® guidelines, do not separately report 76942 Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation with 55974.

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

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John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

3 Responses to “SpaceOAR Gets a Code”

  1. Amaravani Kalahasty says:

    The implant is placed via needle, and placement includes imaging guidance. Per CPT® guidelines, do not separately report 76942 Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation with 55974.

    I guess the above code is 55874. Is it misprinted?

  2. Letty Elizondo says:

    Medicare is denying cpt codes 76942 stating that the referring or ordering provider name is missing; incomplete; or invalid.the rendering provider cannot self refer. These are established patients that are having vein treatments.

  3. Doc Rings says:

    Just called and is covered by TRICARE for military patients (and retirees) who are undergoing pelvic radiation (typically prostate). The code 55874 was used with the Humana operator to confirm it was covered as “medically necessary and preventative to avoid harm”

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