CurrentColorado Rocky Mountain Health PlansPolicy N/A

Therapeutic radiology clinical treatment planning reimbursement (CPT 77261-77263)

Defines reimbursement units and episode-of-care rules for therapeutic radiology clinical treatment planning (CPT 77261, 77262, 77263) for UnitedHealthcare Community Plan Medicaid; applies to services billed on CMS-1500 and UB-04 forms for all products and providers covered by the plan.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyTherapeutic radiology clinical treatment planning reimbursement (CPT 77261-77263)

Policy CodePolicy N/A

Change TypeClarification and administrative updates

Effective Date

Next Review Date

Key ActionProviders must submit accurate claims using CPT 77261/77262/77263 to start and track a 90-day episode and avoid billing units that exceed the reimbursable limits.

SourceLink

POLICY UPDATE CHANGES

Questions and Answers section added clarification that brachytherapy services within a 90-day episode make the unit limitations inapplicable.

State exception list updated multiple times (removals of several states and policy/version number changes).

90episode of care duration

77261-77263planning CPT codes that start an episode

limitedreimbursable units enforced; excess denied

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This policy from UnitedHealthcare Community Plan Medicaid defines reimbursement unit limits and episode-of-care rules for therapeutic radiology clinical treatment planning (CPT 77261, 77262, 77263). It applies to services submitted on CMS-1500 and UB-04 forms for all products and providers covered by the plan. The policy establishes allowed units per 90-day episode and enforces denial of units billed in excess of the specified per-episode limits.

Episode thresholds and key stats

Episode duration90 days

Reimbursable units per episodeSpecified per CPT in Applicable Codes table; units billed in excess of the per-episode limits will be denied

Planning CPT codes that start an episode77261, 77262, 77263

Reimbursable units enforced; excess deniedUnits billed in excess of the reimbursable units per 90-day episode will not be considered for reimbursement and will be denied

OpenPayer

Therapeutic radiology clinical treatment planning reimbursement (CPT 77261-77263)

Policy Snapshot