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Review of Outpatient 3-Dimensional Conformal Radiation Therapy Planning Services

3-Dimensional Conformal Radiation Therapy (3D-CRT) is a radiation therapy technique that allows doctors to sculpt radiation beams to the shape of a patient's tumor. 3D-CRT is provided in two treatment phases: planning and delivery. Hospitals bill Medicare for developing a 3D-CRT treatment plan using Current Procedural Terminology code 77295. Automated prepayment edits prevent additional payments for separately billed radiation planning services if they are billed on the same date of service as the 3D-CRT treatment plan. However, Medicare allows additional payments if they are billed on a different date of service (e.g., 1 day before). For a form of radiation similar to 3D-CRT, Medicare requirements prohibit payments for separately billed radiation planning services when they are billed on a different date of service. We will determine the extent of potential savings to Medicare if it had implemented the same requirements for 3D-CRT planning services.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
July 2018 Centers for Medicare & Medicaid Services Review of Outpatient 3-Dimensional Conformal Radiation Therapy Planning Services Office of Audit Services W-00-18-35812 2019