Brian Lally, President of ACRO – American College of Radiation Oncology, shared on X:
“Remember when CMS said no to this last year in HOPPS?
ASTRO didn’t walk away. They went back this year with better data and secured this win on the rebound.
As the text in the screenshot shows, the commenters’ impact won the day, reassigning CPT 77407 to APC 5623 (> $500 geometric mean cost).
We are persuaded by the commenters that we should reassign CPT code 77407 to APC 5623 (Level 3 Radiation Therapy). We believe that since the revised CPT code 77407 includes the deleted IMRT services (which both had geometric mean costs of over $500), it is appropriate to reassign 77407 to APC 5623. We believe CPT codes 77402 and 77412 are in the appropriate APCs.
Huge credit to the collective assist from ACRO – American College of Radiation Oncology, ACCC, American College of Radiology, and Community Oncology.
Persistence matters.
However… this didn’t cross over to the MPFS. Expecting friction on the professional fee side regarding this split. More in-depth video breakdowns coming shortly.
How is your team handling this?”
CPT 77402 – Level 1: Simple radiation treatment delivery
- Uses conventional 2D photon radiation with relatively simple treatment arrangements.
- Includes electron beam therapy, typically for superficial tumors.
- Requires straightforward positioning and treatment delivery, without complex 3D planning or IMRT.
CPT 77407 – Level 2: Intermediate-complexity radiation treatment delivery
- Includes 3D conformal radiation therapy (3D-CRT), using shaped beams to target tumors.
- Covers IMRT and VMAT delivered using a single isocenter.
- Involves more complex treatment planning to optimize radiation distribution and protect surrounding healthy tissues.
CPT 77412 – Level 3: High-complexity radiation treatment delivery
- Includes treatments requiring multiple isocenters to target different areas.
- Incorporates active motion management, such as respiratory gating or deep inspiration breath hold.
- Covers specialized techniques, including mixed photon-electron fields and total skin electron therapy.
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