Facility/Technical CPT Codes

Facility/Technical CPT Codes 

Current Procedural Terminology (CPT) is a list of descriptive terms and codes for reporting technical services and procedures performed by facilities. The following are CPT codes available for reporting procedures associated with the ExAblate ® System. The definition of the 77XXX codes are specific to radiation and may or may not be appropriate for billing. Each center should assess the use of these codes with each insurer and their fiscal intermediary. CMS has stated that appropriate crosswalking of a code which accurately describes the plan of care can be utilized where no other code for the steps of a procedure exist. Where a CPT code is not available specific to a procedure, the use of an appropriately described CPT code may be used until an appropriate CPT code is obtained. 

CPT	DESCRIPTION	APC	COMMENTS
77295	3-D Simulation	310
77370	Physics Consult	304
77334	Treatment Devices	303	May be multiple
77300	Dosimetry	304	May be multiple
77470	Special Treatment Procedure	299
0071T	Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total leiomyomata volume less than 200cc of tissue	067
0072T	Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total leiomyomata volume greater than or equal to 200cc of tissue	067

Professional Codes
 
The primary CPT codes (0071T and 0072T) have not been valued for professionals at this time. Professionals can crosswalk the procedure to an existing CPT code that has assigned Relative Value Units (RVUs). This crosswalk allows payors to equate an unvalued CPT code to an established CPT code, incorporating utilization of resources (e.g. physician time, skill, effort and judgment) in the valuation. 

Some physicians using the equipment have crosswalked to the following codes. Other physicians have sought and gained a contract amount of payment using the ‘T’ codes. Each physician must decide for themselves how they will code professionally. 

CPT	DESCRIPTION	2010 RVUs
77295	3-D Simulation	16.47
77300*	Dosimetry	1.91
77334*	Treatment Devices	4.20
77470**	Special Treatment	6.06
77435	Stereotactic Body Treatment	18.86

* May be multiples
** As of January 2010, 77470 is considered mutually exclusive with 77435.

NOTICE:
Reimbursement policies differ from insurer to insurer and reimbursement policies of the same insurer may vary in different sections of the country. The information contained in this website, while accurate at the time of posting, may not be accurate at the time of use. Prior to submission of a claim for reimbursement, the user should contact the insurer to verify applicable codes and reimbursement levels, assuming FDA approved.
Copyright Notice:
All five-digit numeric CPT codes, descriptions, instructions and guidelines are Copyright 2009 of the American Medical Association. To purchase AMA's products please contact the American Medical Association at 800-621-8335.

Legal Disclaimer
The listing of codes provided for the professional and the hospital outpatient setting for use with the Exablate 2000® procedure is being provided as a representation and should not be viewed as the billing scenario. This reimbursement model has been prepared by InSightec, Incorporated for illustration of a method of financial analysis concerning the acquisition of InSightec products and/or services. You are advised not to rely upon this information, but to make your own analysis, including verification with hospital billing staff of any underlying assumptions regarding billing practices. This analysis is provided for information purposes only, and InSightec makes no guarantee or representations of its accuracy to your situation.


For more information email: ReimbursementUSA@InSightec.Com