Billing Brachytherapy and payments

Payment for Brachytherapy Sources

Contractors will make payment for separately billable brachytherapy sources furnished by ASCs when furnished in conjunction with a Medicare-approved ASC surgical procedure.

Medicare payment to ASCs for covered brachytherapy sources will be based on acquisition cost or invoice if the code is on the ASC-covered fee schedule list and has a contractor priced indicator of H7.

The following is a listing of brachytherapy source codes that apply:
• A9527 Iodine I 235 sodium iodide
• C1716 Brachytx, non-str, Gold-198.
• C1717 Brachytx, non-str, HDR Ir-192.
• C1719 Brachytx, NS, Non-HDRIr-192.
• C2616 Brachytx, non-str, Yttrium-90.
• C2634 Brachytx, non-str, HA, I-125.
• C2635 Brachytx, non-str, HA, P-103.
• C2636 Brachy linear, non-str, P-103.
• C2638 Brachytx, stranded, I-125.
• C2639 Brachytx, non-stranded, I-125.
• C2640 Brachytx, stranded, P-103.
• C2641 Brachytx, non-stranded, P-103.
• C2642 Brachytx, stranded, C-131.
• C2643 Brachytx, non-stranded, C-131.
• C2698 Brachytx, stranded, NOS.
• C2699 Brachytx, non-stranded, NOS.

Brachytherapy Billing Requirements

• Report the number of units for the brachytherapy sources that were provided integral to covered surgical procedures.
• Brachytherapy sources and the Medicare-approved ASC-covered surgical procedure must be billed on the same claim.
• The invoice for the acquisition of the brachytherapy source(s) and the operative report for the covered surgical procedure must be submitted with the claim.
The complete listing of brachytherapy sources separately payable when provided integral to covered surgical procedures in an ASC are located on the CMS Web site under Addendum BB at:
http://www.cms.hhs.gov/ASCPayment/01_Overview.asp#TopOfPage