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Official Description

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)
Short Descr Complex simulation w/pet-ct
Coverage Carrier Priced
Pricing Indicator(s) 13 – Physician Fee Schedule - Price established by carriers (e.G., not otherwise classified, individual determination, carrier discretion)
MPI A – Not applicable, as HCPCS priced under one methodology
ASC Payment Group Code YY – 1/01/2025
BETOS P7A – Oncology - radiation therapy
TOS Code(s) 6 – Therapeutic radiology
Added Date 1/1/2025
Action Code A – Add procedure or modifier code (effective 1/1/2025)
Status Code Carriers Price the Code
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51) 0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Procedure or Service, Not Discounted when Multiple
MUE Not applicable/unspecified.
MUE Not applicable/unspecified.
OTS Orthotic No
Date
Action
Notes
2025-01-01 Added Code added.
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