Reason Code C7715

Description
Duplicate 3-Dimensional Conformal Radiation Therapy (3D-CRT) Planning Services. Payments for these services are included in the Outpatient PPS payment for Current Procedural Terminology (CPT) code 77295 (Under Medical Radiation Physics, Dosimetry, Treatment Devices, and Special Services for Radiation Treatment), when performed as part of developing a 3D-CRT treatment plan. Under those circumstances, they should not be billed in addition to CPT code 77295 (e.g., 1 to 14 days before).

Planning code 77295 includes the following planning codes within 14 days prior to a Line item date of service (LIDOS) for the same patient at the same provider for the following CPTs:

• 77014
• 77280
• 77285
• 77290
• 77305
• 77306
• 77307
• 77310
• 77315
• 77316
• 77317
• 77318
• 77326
• 77328
• 77336

Resolution
Providers are not permitted to separately bill for these CPT codes within 14 days of 77295 under Outpatient PPS.

Resources

• Office of Inspector General (OIG) Report No. A-09-18-03026 (PDF)
• OIG Review of Outpatient 3-Dimensional Conformal Radiation Therapy Planning Services 
• OIG Report (OIG A-09-16-02033): Medicare Improperly Paid Hospitals Millions of Dollars for Intensity Modulated Radiation Therapy Planning Services (PDF)
• Medicare Claims Processing Manual, Chapter 4, Section 200.3.1 (Instruction for IMRT services coding) (PDF)
• MLN Matters Number: SE18013 (PDF)
• MLN Matters Article MM9658 (PDF)