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denisek1028

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Hello,

For SBRT and SRS, the global period is XXX which means the global concept doesn't apply. Does anyone know if we can bill an E/M outside of this once the patient has completed treatment or do payers, like CMS, treat SBRT and SRS like they do IMRT where it is bundled to the payment and has a 90-day global period? I don't have access to the Astro website so I am unable to look this up on their site.

Any help is appreciated!

Thank you!
 
denisek1028 said:
Hello,

For SBRT and SRS, the global period is XXX which means the global concept doesn't apply. Does anyone know if we can bill an E/M outside of this once the patient has completed treatment or do payers, like CMS, treat SBRT and SRS like they do IMRT where it is bundled to the payment and has a 90-day global period? I don't have access to the Astro website so I am unable to look this up on their site.

Any help is appreciated!

Thank you!
Click to expand...

A few things to clarify:

  • It’s not the treatment delivery code that determines when you can bill E/M after treatment - it’s the physician's treatment management code.
  • With 77427, follow-up exam/care is bundled for 90 days after the last treatment.
  • If you don't have access to the ASTRO book, you can also see this in the Medicare Claims Processing Manual, Chapter 13, 70.1 - Weekly Radiation Therapy Management (CPT 77419 - 77430) and 70.2 - Services Bundled Into Treatment Management Codes
pages 44-47 at this link: https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c13.pdf

Below is an excerpt from page 47 about some of the services bundled into treatment management:


1756485143938.png


Treatment management codes 77431, 77432, 77435, and 77469 do not have global periods, so E/M services that take place after completion of treatment can be billed.

Since 77431, 77432, or 77435 are the treatment management codes for SBRT/SRS services, you can bill E/M services following SBRT and SRS.
 
By the way, even if you don’t have access to the paid ASTRO coding book, the ASTRO website still has a good amount of free coding guidance available for anyone to view:

https://www.astro.org/practice-support/reimbursement/coding/coding-guidance

If your office regularly works with radiation oncology services, someone in the office should ideally have access to the ASTRO coding materials.

Other great references to know about:

RCCS Navigator for Radiation Oncology Services - lots of helpful resources for rad onc coding/billing: https://store.rccsinc.com/collections/radiation-oncology

AMAC – another solid organization with rad onc coding/billing tools. They’re also the ones who offer the ROCC credential: https://amac-usa.com/

Important note: If your employer is willing to invest in rad onc reference books soon, I’d recommend holding off until the 2026 editions are released. The 2026 proposed rule had some major coding changes for radiation oncology. At this point, if your employer is willing to invest some funds, you might as well wait until the 2026 final rule is finalized and get the most current information.

That might even be a way to talk them into investing in a 2026 ASTRO or other reference book for you - sell them on the idea of all the potential changes coming for 2026 and needing to be sure you're doing everything correctly!
 
Forgot to add - there’s also a Facebook group specifically for radiation oncology coders and billers. It has about 1.3K members (and growing daily), including many highly experienced rad onc coders, billers, and even quite a few radiation therapists.

You’re welcome to join and use it as another place to ask radiation therapy coding or billing questions: https://www.facebook.com/groups/radiationoncologycoders
 
sls314 said:
A few things to clarify:

  • It’s not the treatment delivery code that determines when you can bill E/M after treatment - it’s the physician's treatment management code.
  • With 77427, follow-up exam/care is bundled for 90 days after the last treatment.
  • If you don't have access to the ASTRO book, you can also see this in the Medicare Claims Processing Manual, Chapter 13, 70.1 - Weekly Radiation Therapy Management (CPT 77419 - 77430) and 70.2 - Services Bundled Into Treatment Management Codes
pages 44-47 at this link: https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c13.pdf

Below is an excerpt from page 47 about some of the services bundled into treatment management:


View attachment 8112


Treatment management codes 77431, 77432, 77435, and 77469 do not have global periods, so E/M services that take place after completion of treatment can be billed.

Since 77431, 77432, or 77435 are the treatment management codes for SBRT/SRS services, you can bill E/M services following SBRT and SRS.
Click to expand...

Yes, I understand the treatment management is what drives the global period but what is confusing is 77427 has XXX as the global period as well as SRS and SBRT and that is what is confusing and is confusing to some providers.

Have you had success in billing office visits for SBRT or SRS once the patient has completed treatment and is following with the provider within that 90 days?
 
denisek1028 said:
Yes, I understand the treatment management is what drives the global period but what is confusing is 77427 has XXX as the global period as well as SRS and SBRT and that is what is confusing and is confusing to some providers.

Have you had success in billing office visits for SBRT or SRS once the patient has completed treatment and is following with the provider within that 90 days?
Click to expand...

Yes, I bill the office visits after SBRT and SRS all the time. Evaluation and management follow up care is not bundled for the treatment management CPTs 77431-77435

Remember that the global indicator on the Medicare fee schedule is for the global surgical package. It says XXX with 77427 because Global surgical rules do not apply to the radiation treatment management codes.

The 90 day surgical Post-Operative period is something entirely different from the E/M being bundled for 90 days with the 77427.

You can find that in the Medicare Claims Processing Manual chapter that I linked above, where it specifies that 77427 includes follow up examination and care for 90 days after the last treatment.

There's also an excerpt from the ASTRO book relating to radiation treatment management on this thread as well: https://www.aapc.com/discuss/threads/global-period-for-77427.199392/?view=date#post-546599
 
sls314 said:
Yes, I bill the office visits after SBRT and SRS all the time. Evaluation and management follow up care is not bundled for the treatment management CPTs 77431-77435

Remember that the global indicator on the Medicare fee schedule is for the global surgical package. It says XXX with 77427 because Global surgical rules do not apply to the radiation treatment management codes.

The 90 day surgical Post-Operative period is something entirely different from the E/M being bundled for 90 days with the 77427.

You can find that in the Medicare Claims Processing Manual chapter that I linked above, where it specifies that 77427 includes follow up examination and care for 90 days after the last treatment.

There's also an excerpt from the ASTRO book relating to radiation treatment management on this thread as well: https://www.aapc.com/discuss/threads/global-period-for-77427.199392/?view=date#post-546599
Click to expand...
Thank you for this info!
 
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