Currentblue cross blue shield - tennesseePolicy N/A

BCBST Commercial Radiation Therapy Procedure Codes

Defines the set of CPT/HCPCS/procedure codes related to radiation therapy (including brachytherapy, stereotactic radiosurgery/SBRT, proton therapy, treatment planning, delivery, and related devices) used for BCBST Commercial reimbursement; applies to claims and coding for affected services.

Policy Summary

Payerblue cross blue shield - tennessee

PolicyBCBST Commercial Radiation Therapy Procedure Codes

Policy CodePolicy N/A

Change TypeInformational code roster (no material coverage changes)

Effective DateJul 1, 2024

Next Review DateN/A

Key ActionList separately in addition to code for primary procedure when applicable for multiple placement/insertion codes.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~250procedure and HCPCS/CPT codes listed

7/1/2024policy/code activation date

Multiplereactivations noted

Someprior removal entries

Coverage / Procedure Scope

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage/code listing (informational)

Codes and brief descriptions provided for billing and processing; no explicit coverage decision language present in the provided text.

Lists CPT/HCPCS codes for radiation therapy procedures, treatment planning, delivery, brachytherapy, radiopharmaceuticals, and related services

Includes specific code descriptions and effective dates (example entries: 0394T, 0395T, 0745T, 0746T, 0747T, 19294, 19296; delivery and planning codes such as 77385-77387, 77401-77412 are listed)

Contains radiopharmaceutical and brachytherapy source codes (examples: A9513, A9606, C2616, G0339) and brachytherapy procedure codes (e.g., 77761-77778, 77789-77790, 77799)

Billing annotations present such as 'List separately in addition to code for primary procedure' for certain placement/insertion and stereotactic frame application codes

Document functions as an informational reimbursement code roster and does not provide medical necessity clinical criteria or explicit coverage decisions

Some codes show prior removal/reactivation history (entries indicate reactivation or prior term dates, with effective date 7/1/2024 noted for the roster)

(UM+CS) marker appears on the page indicating utilization management/clinical screening applies to these services

CPT, HCPCS and Related Codes

Radiation therapy CPT/HCPCS codesmixed

0394T	HDR electronic brachytherapy, skin surface application, per fraction
0395T	HDR electronic brachytherapy, interstitial or intracavitary treatment, per fraction
0745T	Cardiac focal ablation utilizing radiation therapy for arrhythmia; noninvasive arrhythmia localization and mapping of arrhythmia site (nidus), derived from anatomical image data and electrical data
0773??	Representative set includes treatment planning (77261-77263), simulation (77280-77290), dosimetry (77300-77318), delivery (77401-77412, 77371-77373, 77385-77387) and brachytherapy codes (77761-77778, 77789-77790, 77799)

Billing and Utilization Management Notes

Billing Rule

Billing note - list separately when appropriate

List separately in addition to code for the primary procedure when appropriate — list separately in addition to code for primary procedure appears for multiple placement/insertion codes.

Relevant placement/insertion CPT codes may require separate listing in addition to the primary procedure code.

Prior Authorization

Utilization management/clinical screen

Utilization management / clinical screen (UM+CS) requirement applies. Services listed with the (UM+CS) marker require prior utilization management review or clinical screening per the payer's processes before authorization or reimbursement will be approved.

Codes and services marked with (UM+CS) in this policy require utilization management/clinical screening.
Examples from this policy: CPT codes 19297, 19298, 31643, 32553, 41019 are annotated with (UM+CS).
Confirm prior authorization and clinical documentation requirements with Blue Cross Blue Shield of Tennessee prior to scheduling or performing services.

Terms and Administrative Notes

List separately — administrative note

Definition'List separately' indicates a code that should be billed in addition to the primary procedure (i.e., listed separately in addition to code for primary procedure).

Common usageApplied to multiple placement/insertion and stereotactic radiosurgery add-on codes (examples in list include 49412, 61797, 61799 and others).

Administrative noteWhen present in a code line, treat the code as an adjunct service requiring separate listing on the claim beyond the primary procedure code.

Effective date contextAppears on entries effective 7/1/2024 and carried forward from prior listings (see entries with Start Date 7/1/2020 and reactivation notes).

Reactivated / Removed — administrative note

Meaning'Reactivated / Removed' denotes codes that were previously removed (term date 4/1/2024) and subsequently reactivated with a new effective/reactivation date of 7/1/2024.

ExamplesCodes shown as reactivated 7/1/2024 include 32553, 49411, 49412, and 55876 (these had been marked Removed 4/1/2024 on prior lines).

Operational impactClaims processing should use the reactivation effective date (7/1/2024) for determining code acceptability; prior removal on 4/1/2024 is superseded by the reactivation line.

Source linesReactivation and removal status are displayed inline on code entries (see code start/term date annotations in the roster).