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SHPBN-2017-001 Reinstatement of Coverage of Radiation Therapy G Codes

Fecha: 03/01/17

Effective with date of processing on February 1, 2017, and retroactive to date of service of March 1, 2016, coverage will be reinstated to previously covered benefit plans for the radiation therapy G codes.

The codes were not covered for all benefit plans. The intent of the policy is to return coverage as it was prior to March 11, 2016.

  • G6001 – Ultrasonic guidance for placement of radiation therapy fields
  • G6002 – Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy
  • G6003 – Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or not blocks: up to 5 mev
  • G6004 – Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or not blocks: 6-10 mev
  • G6005 – Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or not blocks: 11-19 mev
  • G6006 – Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or not blocks: 20 mev or greater
  • G6007 – Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 5 mev
  • G6008 - Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 6-10 mev
  • G6009 - Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 11-19 mev
  • G6010 - Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 20 mev or greater
  • G6011 – Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5 mev
  • G6012 - Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 6-10 mev
  • G2013 - Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 11-19 mev
  • G2014 - Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 mev or greater
  • G6015 – Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporary modulated beams, binary, dynamic MLC, per treatment session
  • G6016 – Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator, convergent beam modulated fields, per treatment session
  • G6017 – Intra-fraction localization and track of target or patient motion during delivery or radiation therapy (e.g., 3D positional tracking, gating, 3D surface tracking), each fraction of treatment

Procedure codes G6001-G6017 were previously listed as non-covered, which inadvertently resulted in claim recoupments. This notification serves to reinstate coverage of G6001-G6017 and allow providers to be reimbursed for medically necessary services.

 

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