Effective February 1, 2025, UHC Commercial has introduced a new reimbursement policy with unit limits on dosimetry, simulation, devices, and treatment management services during a 90-day episode of care.
One notable change is the restriction to a maximum of 9 reimbursable units of 77427 within a 90-day period. This additional limitation for 77427 seems unnecessary when 77427 is already limited by definition —once every 5 treatments.
Per the new policy:
One notable change is the restriction to a maximum of 9 reimbursable units of 77427 within a 90-day period. This additional limitation for 77427 seems unnecessary when 77427 is already limited by definition —once every 5 treatments.
Per the new policy:
- Radiation therapy dosimetry, simulation, and management services, identified with select CPT® codes, will have unit limitations during a 90-day episode of care, as noted below. Units billed in excess of the reimbursable units will not be considered for reimbursement.
- These limits apply only to codes for the dosimetry, simulation, and management aspect of radiation therapy treatment planning and not to radiation therapy treatment itself.
- A 90-day episode of care begins when one of the therapeutic radiology treatment planning CPT® codes (77261, 77262 and 77263) are billed. A new episode of care begins again if a radiology treatment planning code is submitted before the previous 90-day episode of care ends