Radioactive sources used in brachytherapy treatment are available in many different forms such as seeds, needles, wires, ribbons, pellets or liquids. Medicare coding and billing for brachytherapy sources (also known as brachytherapy seeds, radioelements, devices) is unique to the site-of-service.
The brachytherapy source(s) is reimbursed when billed in an office or freestanding center (site-of-service 11) using HCPCS Q3001.
Q3001 Radioelements for brachytherapy, any type, each
HCPCS Q3001 may be used to recover the cost of expendable radioelements such as Iodine-125, Palladium-103 and Cesium-131 sources. Only the entity that bears the cost of purchasing the brachytherapy source(s) may bill this code. Sources used for remote afterloading high intensity brachytherapy (also known as High Dose Rate Brachytherapy) are not separately payable in the office or freestanding center setting.
For Medicare, HCPCS Q3001 is “carrier-priced.” There is no national Medicare payment rate for Q3001. The carrier has the discretion to assign a price. When the service is performed in the physician's office or freestanding center, the correct method to report the sources is the following:
It is recognized that a small number of additional seeds may be ordered and billed to cover plan changes or intraoperative loss.
Medicare makes separate payment for both Low Dose Rate (LDR) and High Dose Rate (HDR) sources in addition to brachytherapy treatment delivery when provided in a hospital outpatient department or ambulatory surgical center (ASC).
CMS has designated HCPCS Level II codes for separately reimbursed radiation sources to report stranded (embedded into the stranded suture material and separate within the strand by material of an absorbable nature at specific intervals) and non-stranded sources. If facilities use both stranded and non-stranded sources for the same patient, they can separately report each type of service.
The following codes should be used to report sources in the hospital outpatient setting.
|A9527||Iodine I-125, sodium iodide solution, therapeutic, per mCi|
|C1716||Brachytherapy source, Gold-198, per source|
|C1717||Brachytherapy source, High Dose Rate Iridium-192, per source|
|C1719||Brachytherapy source, Non-High Dose Rate Iridium-192, per source|
|C2616||Brachytherapy source, Yttrium-90, per source|
|C2634||Brachytherapy source, High Activity, Iodine-125, greater than 1.01 mCi (NIST), per source|
|C2635||Brachytherapy source, High Activity, Palladium-103, greater than 2.2 mCi (NIST), per source|
|C2636||Brachytherapy linear source, Palladium-103, per 1MM|
|C2637||Brachytherapy source, Ytterbium-169, per source|
|C2638||Brachytherapy source, stranded, Iodine-125, per source|
|C2639||Brachytherapy source, non-stranded, Iodine-125, per source|
|C2640||Brachytherapy source, stranded, Palladium-103, per source|
|C2641||Brachytherapy source, non-stranded, Palladium-103, per source|
|C2642||Brachytherapy source, stranded, Cesium-131, per source|
|C2643||Brachytherapy source, non-stranded, Cesium-131, per source|
|C2644||Brachytherapy source, Cesium-131 chloride solution, per mCi|
|C2645||Brachytherapy planar source, Palladium-103, per square millimeter|
Brachytherapy sources are paid separately from the services to administer and deliver brachytherapy in the hospital outpatient and ASC setting. Payment reflects the number, isotope and radioactive intensity of devices furnished, as well as stranded versus non-stranded configurations of sources. Seed-like sources are generally billed and paid “per source” based on the number of units of the HCPCS source code reported, including the number of sources within a stranded configuration. It is important to use the source specific C-code that best describes the radioelement used. Note that when billing for stranded sources, providers should bill the number of units of the appropriate source HCPCS C-code according to the number of brachytherapy sources in the strand, and should not bill as one unit per strand.
In the case where most, but not all, prescribed sources are implanted in the patient, Medicare will pay for the relatively few brachytherapy sources that are ordered but not implanted. The hospital may charge for all sources if they are specifically acquired by the hospital for the particular patient according to a physician's prescription, in order to ensure that the clinically appropriate number of sources are available and not implanted in any other patient. Sources not implanted must be correctly disposed of, and the sources would typically constitute a small fraction of the total ordered.
For Medicare patients, the hospital may report the codes for brachytherapy needles and catheters. No additional payment will be made for these devices; however, they will be used to track the cost for future ambulatory payment classification (APC) rate calculations. Your hospital may itemize miscellaneous supplies on bills by using revenue codes. If you use revenue codes, the speciﬁc date of service should appear with each code. By providing the date of service it will allow Medicare to set payment rates more accurately in the future.
Physicians (and physician offices or freestanding centers) should not bill these codes because the codes only apply to the hospital outpatient setting.
The actual reimbursement for sources in hospital outpatient departments and ambulatory surgical centers is based on cost and charge data that is reported by individual departments and centers. The reimbursements each year are based upon the date that was submitted two years earlier.
Below are suggestions on how to calculate charges for single use brachytherapy sources so that you receive future reimbursement for the sources at their full cost.
In order to recover any departmental overhead costs, the charge would need to be more than these calculated amounts. Remember the charges for the single use sources are per source, so you must enter the number of sources used on each claim in the “units” ﬁeld.
The radiation source or brachytherapy seed is billed based on the type used. Don't forget to bill the correct number of units! Medicare will pay you per source, so it is very important to make sure the number of sources used is indicated in the “units” ﬁeld of your billing system. It is appropriate to bill for all the sources ordered for an individual patient, even if some are wasted and not implanted in the patient.
Determining a charge for High Dose Rate Iridium-192 (C1717) is a bit more complicated, because these sources are used for multiple patients. HCPCS code C1717 is the source used in HDR remote after-loading procedures. This source will also be paid by Medicare by multiplying your charge and your hospitals cost-to-charge ratio.
In order to cover your costs for this source you need to set your charge carefully. The following steps will help you determine an accurate charge for HCPCS C1717. This is estimated on your utilization and costs for a quarter. It calculates a charge that will result in reimbursement of your direct costs for the source. If you need to recover administrative overhead the charge would need to be higher. These charges are calculated per treatment, when billing a single treatment the number of units should be one.
Setting Medicare charges for brachytherapy sources accurately is important so that your facility does not lose money. Medicare pays for brachytherapy sources by multiplying the hospital's charge as it appears on the claim by the hospital's cost-to-charge ratio as calculated from the cost report. If your charge is the published payment rate, your payment will be reduced below this charge based on your hospital's average mark-up over costs.
Complete and correct brachytherapy source coding and setting accurate charges for each source significantly impacts hospital payment and the ability to offer brachytherapy to Medicare beneficiaries.
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