Crosswalking Rad/Onc codes between plans

Jessim929

Guru
Messages
112
Best answers
0
I have a question regarding crosswalking Radiation Oncology codes between a commercial primary insurance plan and Medicare as secondary.

Is it normal for one CPT: 77385 to crosswalk into two HCPCs codes? Patient is receiving IMRT for prostate cancer. BCBS is primary and paid the 77385. Medicare is secondary and wants the G-codes. (G6015 and one other that I can't remember.) Do I just bill the one code or do I need both?

Any guidance or insight is VERY appreciated!!
 

emhuddle

New
Messages
1
Best answers
0
In a freestanding cancer center, there are 2 IMRT codes. The first is G6015, this is probably the one you want. The other is G6016 and is used for compensator based IMRT.
 
Messages
6
Location
Seattle, WA
Best answers
0
CPT 77385 is for IMRT Delivery that includes guidance and tracking; Simple - in Hospital Setting. G6015 is IMRT Delivery; single or multiple fields/arcs, via narrow spatially and temporally modulated beams, binary, dynamic Multi-leaf Collimator (MLC) device, per treatment session - in Office/Non-excepted Provider-Based Setting.
 

Jessim929

Guru
Messages
112
Best answers
0
So, it's totally a parallel to bill 77385 and G6015? It's not apples and oranges?

Is there an online resource to find this stuff in the future?
 
Last edited:

astuart@pmsia.com

Networker
Messages
44
Location
Hiawatha, IA
Best answers
0
More like apples (G6015) to red-apples (77385) and green-apples (77386). :)

Yes it is written that the 77385-77386 are for hospital based and the G6015 is for free-standing...but real world for free standing is payer specific. I'm not sure where you are located but what we have found is that Medicares, Medicaids, and most MCOs require the G6015 but about 75% of our commercial payers want the 77385-77386 and the rest still want the G6015. Take a look at your payer fee schedules, they will usually have one or the other and then you will know which one to use for which payer.
This does create a problem in the scenario that you asked about when Medicare is secondary. We have received directive from Medicare that we can crosswalk to the G6015 for secondaries. We also have a few supplement policies that want the 77xxx codes so have to cross the other way too.

Depending on which way you crosswalk...
77385 (for prostate or breast cancer) = G6015
77386 (for all other diagnosis codes) = G6015
77385 (for compensator-based IMRT) = G6016 (if you aren't clinical, just ask someone in the department if they do this.)

G6015 crosses back to either 77385 or 77386 depending on diagnosis (as above)

Hope this helps. I don't have an online resource to share that we don't subscribe to but I'm sure you can find info on it by looking up the 2015 CPT changes.

Alanna

Physician Management Services
astuart@pmsia.com
 
Top