Summary & Overview
CPT 79200: Intracavitary Radiopharmaceutical Administration
Headline: CPT code 79200: Direct Intracavitary Radiopharmaceutical Administration
Lead: CPT code 79200 covers the placement of a radiopharmaceutical directly into a body cavity or bodily space, such as uterine intracavitary instillation. This targeted approach is used for diagnostic or therapeutic purposes and requires specialized facilities and radiation safety measures.
CPT code 79200 represents a procedural service for intracavitary administration of radiopharmaceuticals. Nationally, accurate coding for this service affects billing clarity, compliance with radiation safety regulations, and appropriate payer reimbursement for procedures that occur in hospital outpatient departments, ambulatory surgical centers, or specialized procedural suites.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The section outlines common coverage patterns and payment considerations across major national payers.
Readers will learn: an overview of what CPT code 79200 represents clinically; typical sites of service and operational considerations; payer coverage landscape and where to find policy details; and the types of benchmarks and policy updates that affect coding and billing for intracavitary radiopharmaceutical procedures. Data not available in the input will be identified where applicable.
Billing Code Overview
CPT code 79200 describes the direct instillation of a radiopharmaceutical substance into a body cavity or space, for example into the uterus. This procedure involves placing a radioactive therapeutic or diagnostic agent directly at a target site within the body rather than administering it systemically.
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Service type: Intracavitary radiopharmaceutical administration
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Typical site of service: Ambulatory surgical center, hospital outpatient department, or specialized procedural suite where radiopharmaceutical handling and radiation safety protocols are available.
Clinical & Coding Specifications
Clinical Context
A typical patient is a postmenopausal woman with recurrent uterine bleeding and known endometrial hyperplasia who is scheduled for an intracavitary radiopharmaceutical instillation to ablate the endometrium. In the outpatient procedural suite or ambulatory surgery center, the workflow begins with pre-procedure consent and verification, confirmation of pregnancy status if applicable, and removal of any intrauterine device. The patient is positioned in lithotomy, a speculum is placed, and the cervix is cleansed. A uterine sound or catheter is inserted under sterile technique to confirm cavity depth and position. A measured radiopharmaceutical dose is prepared by nuclear medicine pharmacy and delivered into the uterine cavity via a syringe or delivery catheter. The provider documents the radiopharmaceutical identity, activity, lot number, volume instilled, and dwell time. Post-procedure, the patient is monitored for vital signs, bleeding, or cramping, provided discharge instructions, and scheduled for follow-up imaging or clinical assessment as indicated. Typical sites of service are the ambulatory surgery center, hospital outpatient department, or nuclear medicine department where sterile supplies and radiation safety oversight are available. The service type is an intracavitary radiopharmaceutical administration.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the service required substantially greater physician work than typical for due to complexity or unexpected difficulty |