Revised guidelines for E&M

CR11137 revises Chapter 13 of the Medicare Claims Processing Manual to allow providers to bill E/M codes 99211, 99212, and 99213 for Levels I through III effective from January 1, 2019, when performed with superficial radiation treatment delivery (up to 200 kV), when performed for the purpose of reporting physician work associated with,

  • Radiation therapy planning
  • Radiation treatment device construction
  • Radiation treatment management when performed on the same date of service as superficial radiation treatment delivery.

According to Current Procedural Terminology (CPT) guidance, providers should not report superficial radiation (up to 200 kV) with CPT codes for planning and management.

Billing of these E/M codes with modifier 25 may be necessary if National Correct Coding Initiative (NCCI) edits apply.

Source: Revised E/M Guidelines for Superficial Radiation Treatment

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