Wiki Urology codes for HDR - Prostate

[DCarrier0626]

We are starting to do a new radiation therapy procedure - HDR for prostate cancer. It is being performed with the services of a Radiation Oncologist and a Urologist as an inpatient procedure. I am trying to find out what the CPT codes might be for the urology service. Any information would be helpful.

 

[teblizzy]

For the Urologist who is participating in the HDR prostate procedure they will typically bill for the placement of the needles used, much like they would for a prostate seed implant. CPT code 55875 for the placement of the needles into the prostate and they will bill for the professional component of the imaging used to place the needles, typically US code 76965.

Hope this helps!

 

[michelleaapc2012]

Does anyone know why United Health Care denies this procedure when performed in an office setting? CPT 55875 and 76965. The fee schedule reflects 55875 can be performed as inpatient or office, but they deny claims that are performed in the office. An appeal has to be filed every single time. It is more cost effective for UHC and the patient when performed in the office so it doesn't make sense for UHC to prefer the place of service to be inpatient. Just curious if anyone else has any thoughts on this or has this issue. Please comment.