Health Information Management

Q/A: Is CMS reducing payment for CPT code 77371?

APCs Insider, March 29, 2013

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Q: We heard that CMS will reduce payment for CPT® code 77371 (radiation treatment delivery, stereotactic radiosurgery [SRS], complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source cobalt 60 based) beginning in April. Is this true?

A: Yes, this is true. CMS notes in Transmittal R2664CP that the payment for CPT 77371 will be reduced to match the payment for HCPCS code G0173. Section 634 of the American Taxpayer Relief Act of 2012 requires that the payment for Cobalt-60 based SRS (CPT 77371) be the same as that for a linear accelerator based SRS procedure (G0173).
 
CMS assigned CPT 77371 to APC 0127(level IV Ssereotactic eadiosurgery, MRgFUS, and MEG) and G0173 to APC 0067 (level III stereotactic radiosurgery, MRgFUS, and MEG). The APC assignments will remain the same, but the payment amounts will be the same for the two codes.
 
The exception is for rural and sole community hospitals for whom the payment rate for CPT 77371 will remain at the APC 0127 rate. The OCE Pricer will calculate the appropriate payment rate based on the site of service where the procedure is performed.
 
Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.



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