Billing Radiation Therapy Codes 77301 and 77014

[Sarah8307]

I am getting denials through Aetna for 77014 because their policy states you cannot bill 77014 60 days before or after billing code 77301. Is anyone else having this issue with any other payers?

Thanks

 

[gabid620]

Same for us, but just with Aetna as well. We're reaching out to ASTRO to see if we have grounds for appeal.

 

[Sarah8307]

Please let me know what you find out. I am reaching out as well to see if there is anything we can do. I will post what I find out. Thanks

 

[TammyHF]

We are also having this issue with Aetna. Please keep us posted.

Thank you!!!

 

[Sarah8307]

I was told to appeal this. I sent my appeal today, I will keep you updated.

 

[TammyHF]

Here is that latest we got from the Aetna denial. This edit is placed by 3rd party I-health review. They want the policy with Medicare stating that they allow codes to be billed. Would the LCD policy for IMRT be best to send?

Thank you,
Tammy

 

[OncologyOKC]

When you look at the fee schedule via CMS the global surgery indicator shows 77301 with a global days as XXX, I would think you could use that to appeal with Aetna since per CMS XXX means that the global concept does not apply.

 

[gabid620]

After our initial reconsideration the denial was upheld. We sent a letter citing ASTRO guidelines and the attached letter from ASTRO to Aetna regarding their policy. We are now in the process of doing a formal appeal.

Fingers crossed.

 

[daragan]

I'm so glad to see I'm not the only one having issues. I thought I had missed a change is guidelines along the way as our billing company started adjusting these as global without informing us. Thank you for the ASTRO letter. I will add it to my appeal attachments.

 

[denisek1028]

Thank you for this info! We are also getting denials not only from Aetna but also United Healthcare! I will appeal these and hope they get paid!

 

[Emmalia]

Has anyone had any luck with these? I saw on the ASTRO website they published a letter from Aetna stating they are keeping their current policy but per CPT the appropriate code to use is 77387-26.

 

[gabid620]

We have had no luck. We're now billing 77387 and taking the reduced reimbursement to get something rather than nothing.

 

[Csimens]

Aetna Denial of 77014

In the ASTRO letter, it specifically states that Aetna is requesting 77387 for modifier 26. If we bill only the Technical component for one of our locations, would the 77387-TC apply or is it only for professional and global?

 

[KN]

Aetna 77014/77387

Although this issue has been resolved with Aetna and they choose to use code 77387 instead of code 77014, what have you experienced with payments? We have now reduced payment for this service. Additionally, the posting burden this has caused is extreme.

 

[Nik80]

Aetna 77387 reimbursement rate

We had the same issues with Aetna not accepting 77014. After appeals and disputes with provider representatives and medical directors, Aetna refused to accept 77014. The reimbursement for 77387 is significantly less than 77014, therefore, we came to an agreement to bill 77387, and Aetna agreed to reimburse 77387 with a rate comparable to 77014. An amendment was then made to our contract for the increase rate.