Evaluation and Management (E/M) When Performed with Superficial Radiation Treatment - Revised

MLN Matters Number: MM11137 Revised
Related CR Release Date: March 27, 2019
Related CR Transmittal Number: R4267CP
Related Change Request (CR) Number: 11137
Effective Date: January 1, 2019
Implementation Date: March 25, 2019

Note: CMS revised this article on March 28, 2019, to reflect the revised CR 11137 that CMS posted on March 27. CMS revised the CR to clarify that providers need to bill the 25 modifier when performing E/M services with CPT code 77401. CMS revised the article to show that change. Also, CMS revised the CR release date, transmittal number, and the web address of the CR. All other information is unchanged.

CR11137 revises Chapter 13 of the Medicare Claims Processing Manual to allow providers to bill E/M codes 99211, 99212, and 99213 for Levels I through III, when performed with superficial radiation treatment delivery (up to 200 kV), when performed for the purpose of reporting physician work associated with:

  • Radiation therapy planning
  • Radiation treatment device construction
  • Radiation treatment management when performed on the same date of service as superficial radiation treatment delivery

Make sure your billing staffs are aware of these revisions.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)11137.


Last Updated Apr 02, 2019