To answer your questions regarding the professional component of IGRT (77014-26, G6002-26, etc):
SBRT (Stereotactic Body Radiation Therapy):
Image guidance is not separately billable by either the physician or the facility. For the physician, it is bundled into the treatment management code, 77435.
77435 - Stereotactic body radiation therapy, treatment management, per treatment course, to one or more lesions, including image guidance; entire course not to exceed five fractions.
IMRT (Intensity-Modulated Radiation Therapy):
In the hospital outpatient setting, the physician can bill for the professional component of IGRT (using modifier -26). The facility cannot bill separately, as IGRT is bundled into the OPPS reimbursement.
3D Radiation Therapy:
In the hospital outpatient setting, both the physician and the facility may bill for IGRT. The physician would report the professional component with the -26 modifier.
Remember that commercial payers often require prior authorization for IGRT and may limit coverage based on diagnosis. For instance, IGRT is typically not approved for skin cancers, because the lesion can typically visualized without image guidance.
Helpful Resources:
If you're working in billing, coding, or prior authorizations for radiation oncology, I highly recommend exploring the following:
ASTRO: The American Society for Radiation Oncology offers excellent coding resources. ASTRO's website includes some free coding guidance,
including a useful chart for billing IGRT by treatment type and setting: https://www.astro.org/practice-supp...rticles/image-guided-radiation-therapy-(igrt)
I'd also recommend having your organization invest in ASTRO’s annual coding resource book.
Navigator for Radiation Oncology (by RCCS): Another comprehensive coding and billing reference. RCCS also offers some courses in rad onc coding.
https://store.rccsinc.com/collections/radiation-oncology
AMAC: Offers additional rad onc coding resources and the ROCC (Radiation Oncology Certified Coder) certification. I currently hold this certification through them.
https://amac-usa.com/
Facebook Group:
I also run a Radiation Oncology Coders and Billers group on Facebook. It’s a growing community of over 1,100 members with a wide range of experience, and there are a lot of experienced rad onc coders who are willing to answer questions: