How To Use HCPCS Code C9794

HCPCS code C9794 describes a therapeutic radiology simulation-aided field setting that is complex and includes the acquisition of PET and CT imaging data required for radiopharmaceutical-directed radiation therapy treatment planning. This code is used to identify a specific procedure that is performed to aid in the planning and delivery of radiation therapy treatment for patients.

1. What is HCPCS C9794?

HCPCS code C9794 is a specific code that is used to identify a therapeutic radiology simulation-aided field setting. This procedure involves the use of PET and CT imaging data to assist in the planning and delivery of radiation therapy treatment. It is a complex procedure that requires specialized equipment and expertise.

2. Official Description

The official description of HCPCS code C9794 is “Therapeutic radiology simulation-aided field setting; complex, including acquisition of PET and CT imaging data required for radiopharmaceutical-directed radiation therapy treatment planning (i.e., modeling)”. The short description for this code is “Enteral supp not otherwise c”.

3. Procedure

1. The provider begins by acquiring PET and CT imaging data from the patient.
2. Using this imaging data, the provider performs radiopharmaceutical-directed radiation therapy treatment planning.
3. This planning involves modeling the radiation therapy treatment to ensure accurate and effective delivery.
4. The provider sets up the therapeutic radiology simulation-aided field, taking into account the specific treatment plan.
5. The patient undergoes the radiation therapy treatment as planned.

4. When to use HCPCS code C9794

HCPCS code C9794 should be used when a provider performs a therapeutic radiology simulation-aided field setting that is complex and includes the acquisition of PET and CT imaging data required for radiopharmaceutical-directed radiation therapy treatment planning. This code is specific to this procedure and should not be used for other types of radiation therapy treatments.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9794, healthcare providers need to document the specific details of the procedure, including the acquisition of PET and CT imaging data, the treatment planning process, and the setup of the therapeutic radiology simulation-aided field. This documentation is necessary for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9794 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code C9794 is covered by Medicare and other insurance providers. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, which means it is not applicable as HCPCS priced under one methodology. Providers should follow the specific guidelines and requirements of Medicare and other insurance carriers when billing for this procedure.

8. Examples

Here are five examples of when HCPCS code C9794 should be billed:

1. A patient with a complex cancer diagnosis undergoes a therapeutic radiology simulation-aided field setting to plan and deliver radiation therapy treatment.
2. A provider acquires PET and CT imaging data for a patient with a specific type of tumor, using this data to plan the radiation therapy treatment.
3. A patient with a history of previous radiation therapy treatments requires a therapeutic radiology simulation-aided field setting to plan a new course of treatment.
4. A provider performs a complex therapeutic radiology simulation-aided field setting for a patient with a rare and challenging case.
5. A patient with a specific genetic mutation undergoes a therapeutic radiology simulation-aided field setting to ensure targeted and effective radiation therapy treatment.