How To Use HCPCS Code C9795

HCPCS code C9795 describes stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, with the entire course not exceeding 5 fractions. This code is used to identify a specific procedure that involves the precise delivery of radiation therapy to target lesions in the body.

1. What is HCPCS C9795?

HCPCS code C9795 is a specific code used in medical coding to identify the procedure of stereotactic body radiation therapy. It is important for medical coders to accurately assign this code to ensure proper billing and reimbursement for the healthcare provider.

2. Official Description

The official description of HCPCS code C9795 is “Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, with the entire course not exceeding 5 fractions.” The short description for this code is “Parenteral supp not othrws c.”

3. Procedure

1. The procedure of stereotactic body radiation therapy involves the precise delivery of radiation to one or more lesions in the body.
2. Image guidance is used to accurately target the lesions and ensure the radiation is delivered to the intended area.
3. Real-time positron emissions-based delivery adjustments are made during the procedure to optimize the radiation treatment.
4. The entire course of treatment should not exceed 5 fractions.

4. When to use HCPCS code C9795

HCPCS code C9795 should be used when a healthcare provider performs stereotactic body radiation therapy, per fraction, to one or more lesions. It is important to note that the entire course of treatment should not exceed 5 fractions. This code is used to accurately identify and bill for this specific procedure.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C9795, healthcare providers should ensure that the documentation supports the use of stereotactic body radiation therapy and includes details such as the number of lesions treated and the use of image guidance and real-time positron emissions-based delivery adjustments. Proper documentation is essential for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code C9795 was added to the Healthcare Common Procedure Coding System on January 1, 1985. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important for medical coders to stay updated on any changes or revisions to the code to ensure accurate coding and billing.

7. Medicare and Insurance Coverage

HCPCS code C9795 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. Healthcare providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for more information on coverage and reimbursement.

8. Examples

Here are five examples of when HCPCS code C9795 should be billed:

1. A patient with multiple lung lesions undergoes stereotactic body radiation therapy with image guidance and real-time positron emissions-based delivery adjustments. The treatment consists of 3 fractions.
2. A patient with a single liver lesion receives stereotactic body radiation therapy with image guidance and real-time positron emissions-based delivery adjustments. The treatment consists of 5 fractions.
3. A patient with a spinal lesion undergoes stereotactic body radiation therapy with image guidance and real-time positron emissions-based delivery adjustments. The treatment consists of 2 fractions.
4. A patient with brain metastases receives stereotactic body radiation therapy with image guidance and real-time positron emissions-based delivery adjustments. The treatment consists of 4 fractions.
5. A patient with a renal lesion undergoes stereotactic body radiation therapy with image guidance and real-time positron emissions-based delivery adjustments. The treatment consists of 1 fraction.