Reimbursement

As an independent CyberKnife center, we are experts in ensuring that proper reimbursement guidelines are followed. For all participating physicians, we are here to help you with any and all of your reimbursement questions.

Coding Overview

Coding policies recognize two distinct approaches to CyberKnife® Robotic Radiosurgery, single session or fractionated. The single session approach generally takes at least three days for set up, planning, and delivery, and the fractionated approach requires up to four additional days. Both the facility and the physicians can code and bill separately for the services provided. Depending on the place of service, billing administrators use a variety of payment methodologies:

– Ambulatory Payment Classifications (APC)/Hospital Outpatient
– Centers for Medicare and Medicaid (CMS) Carrier Codes/Hospital Outpatient
– Current Procedural Terminology (CPT) Codes/Physicians and Hospital Outpatient

Administrators should review these codes prior to establishing a physician superbill or charge description master (CDM).

Menu of Codes for Physicians Reporting Stereotactic Radiosurgery

Cranial (professional component):

– 61796 Stereotactic radiosurgery; 1 simple cranial lesion
– 61797 Stereotactic radiosurgery; each additional cranial lesion
– 61798 Stereotactic radiosurgery; 1 complex cranial lesion
– 61799 Stereotactic radiosurgery; each additional complex cranial lesion

Spinal (professional component):

– 63620 Stereotactic radiosurgery; 1 simple spinal lesion
– 63621 Stereotactic radiosurgery; each additional spinal lesion

Extracranial (professional component):

Prior to January 1, 2009, physicians participating in stereotactic radiosurgery used CPT Code 61793 for all body systems. Effective January 1, 2009, the AMA deleted 61793. Physicians participating in extracranial stereotactic radiosurgery (all areas except cranial and spinal) must now use unlisted CPT Codes for the appropriate body systems. Physicians billing unlisted codes should contact payers to find out what information to put in block #19 of CMS Form 1500.

Click here for a procedure explanation for filing SBRT unlisted code claims with Trailblazer.

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