How To Use CPT Code 0395T

CPT 0395T describes a high dose rate electronic brachytherapy procedure that involves the use of a catheter loaded with a radioactive substance to treat tumors. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0395T?

CPT 0395T can be used to describe a high dose rate electronic brachytherapy procedure. This procedure involves the placement of a catheter within the cancerous tissue or body cavity, loaded with a high energy radioactive substance to treat tumors. The code includes basic dosimetry, which is the calculation of the dose of the radioactive substance before loading it into the catheter. It is important to note that CPT 0395T should not be reported in conjunction with other specified codes.

2. Official Description

The official description of CPT code 0395T is: ‘High dose rate electronic brachytherapy, interstitial or intracavitary treatment, per fraction, includes basic dosimetry, when performed.’

3. Procedure

1. In this procedure, the provider places a catheter within the cancerous tissue (interstitial) or within the body cavity (intracavitary), loaded with a high energy radioactive substance to treat the tumors.
2. The procedure includes dose calculation (dosimetry) of the radioactive substance before loading into the catheter, when performed.
3. Use this code for each fraction or portion that the provider delivers of the planned total dose.

4. Qualifying circumstances

Patients eligible for CPT 0395T are those who require high dose rate electronic brachytherapy treatment for tumors. This procedure is typically used for patients with cancer, where the provider places a radioactive source in, on, or near the tumor to reduce radiation exposure to surrounding healthy tissues. It is important to note that CPT 0395T should not be reported in conjunction with other specified codes.

5. When to use CPT code 0395T

CPT code 0395T should be used when a provider performs a high dose rate electronic brachytherapy procedure, either interstitially or intracavitary, to treat tumors. It is important to note that this code should not be reported with other specified codes. If the provider is treating tumors on the skin, a different code, CPT 0394T, should be used.

6. Documentation requirements

To support a claim for CPT 0395T, the provider must document the following information:

• Specific details of the procedure performed, including the placement of the catheter and the use of the radioactive substance
• Date and duration of the procedure
• Calculation of the dose of the radioactive substance before loading it into the catheter
• Any additional relevant information, such as the type and stage of cancer being treated
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 0395T, ensure that the procedure meets the criteria for high dose rate electronic brachytherapy and that it is not reported with other specified codes. It is important to note that some payers may consider this technology investigational, so coverage may vary. It is recommended to check with Medicare or other payers to determine their coverage policies.

8. Historical information

CPT 0395T was added to the Current Procedural Terminology system on January 1, 2016. There have been no updates to the code since its addition.

9. Examples

1. A provider performing a high dose rate electronic brachytherapy procedure to treat prostate cancer.
2. A provider using CPT 0395T to treat cervical cancer with interstitial brachytherapy.
3. A provider using CPT 0395T to treat breast cancer with intracavitary brachytherapy.
4. A provider performing a high dose rate electronic brachytherapy procedure to treat lung cancer.
5. A provider using CPT 0395T to treat vaginal cancer with interstitial brachytherapy.
6. A provider using CPT 0395T to treat rectal cancer with intracavitary brachytherapy.
7. A provider performing a high dose rate electronic brachytherapy procedure to treat head and neck cancer.
8. A provider using CPT 0395T to treat endometrial cancer with interstitial brachytherapy.
9. A provider using CPT 0395T to treat esophageal cancer with intracavitary brachytherapy.
10. A provider performing a high dose rate electronic brachytherapy procedure to treat skin cancer.