Effective January 1, 2010, Code 77338 replaces device charge 77334 used for each multileaf pattern for
Medicare patients receiving IMRT. This code is used one time per IMRT
plan (77301) and replaces multiple charges for multileaf patterns. Private insurers may not yet have followed suit. Unfortunately, the reimbursement for this code is below what would be reimbursed under the prior system.
Prior to 2010, if a head and neck cancer patient received a ten beam, ten gantry angle, IMRT treatment, code 77334 was billed for a quantity of ten separate multileaf patterns used in treatment. Currently, code 77338 replaces ALL of these charges and can only be billed with quantity of one, not ten.
Current Florida reimbursement for 77338 is $459 and for 77334 is $145. Thus one charge of 77338 represents 3.2 charges of 77334, enough to pay for only 3.2 of the multileaf patterns for the above head and neck cancer patient.
When simulation occurs and custom treatment devices for immobilization are used (ie-aquaplast masks), code 77334, complex treatment device can still be billed. As with all charges, appropriate documentation is essential.
Paul J. Schilling, MD, FACRO
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Code 77338 replaces 77334 Multiple Custom
Multileaf Device Charges for Medicare IMRT Patients.
