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Thread: Guidance guidelines cms

  1. #1

    Default Guidance guidelines cms

    AAPC: Back to School
    Can anyone give me direction where I can find documentation on the guidlines for CMS on one guidance per encounter for Medicare? Any help would be appreciated. I can not seem to find information in writing to show my supervisor.
    Thank you

  2. #2
    Join Date
    Apr 2007
    Murfreesboro, TN


    What kind of "guidance" are you referring to? Is this a radiation oncology question? (I ask that because we use image guidance for treatment and simulation but most payors won't pay for them both on the same DOS, especially Medicare).

  3. #3
    Join Date
    Apr 2007
    Alexandria, LA


    Hi Lynne (long time no see!)
    CMS published the following in the NCCI Policy Manual, Chapter 9 (section G)

    3. CPT codes 76942, 77002, 77003, 77012, and 77021 describe radiologic guidance for needle placement by different modalities. CMS payment policy allows one unit of service for any of these codes at a single patient encounter regardless of the number of needle placements performed. The unit of service for these codes is the patient encounter, not number of lesions, number of aspirations, number of biopsies, number of injections, or number of localizations.

    The policy manual can be found at http://www.cms.gov/NationalCorrectCodInitEd/

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