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MEDICAID CODING GUIDELINE Effective: 5-1-02

INTENSITY MODULATED RADIOTHERAPY CPT CODES:

77301

Intensity modulated radiotherapy plan, including dose volume histograms for target and critical structure partial tolerance specifications Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams(eg, binary, dynamic MLC) per treatment session

77418

Code 76950 (ultrasonic guidance for placement of radiation therapy fields) would be allowed along with 77418. Bill 77418 for each session provided. This code is based on approximately 60 minutes of radiation technician time.

CDR 2002 Federal Register, Nov. 2001 SP/ 4-30-02

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