Hi all,

I wonder if someone who has had successful reimbursement for RT from either a private medical plan or from Medicare would be kind enough to tell me the medical codes used. My provider is still being turned down for Medicare reimbursement with the message, “the information provided does not support the need for this service”—maybe it’s the information provided and not the codes but I’d like to make sure.

Here are the codes they have used for billing:
Radiation treatment delivery – 77416
Radiation Tx management x 5 –77427
Radiation phsyics consult -- 77336
Set radiation therapy field -- 77290
Radiation therapy planning -- 77263
Radiation therapy does plan -- 77334
Special teletx port plan -- 77321
Radiation treatment aids 77334

I’d also be curious if anyone else had these many codes used. This provider is a master as billing every conceivable minute of medical treatment. The total bill for all of the above—which was for 5 days of treatment only-- was $10,445. How does that compare to what you were billed?

Thanks very much,
Diane (Moondanc)

Here are the codes they have used for billing:
Radiation treatment delivery – 77416......MINE SHOWS 77414
Radiation Tx management x 5 –77427......MINE DOESN'T SHOW THIS
Radiation phsyics consult -- 77336..........MINE IS SAME
Set radiation therapy field -- 77290.........MINE IS 77280 & 77290
Radiation therapy planning -- 77263.........MINE DOESN'T SHOW THIS
Radiation therapy does plan -- 77334.......MINE IS 77300
Special teletx port plan -- 77321.............MINE IS SAME
Radiation treatment aids 77334...............MINE IS SAME


Diane,
I had 10 days of RT at Scripps in LaJolla,Ca. The Summary of Payment I got from Medicare indicates some codes same as yours, others are different. I have the differences next to yours (above). Additionally my claim had a charge of $599 for a CT scan (code 77014). The total Medicare Claim including the CTscan was almost $13,000 for the ten days, of which Medicare PAID Scripps approx. $2600. A claim was sent to my secondary Ins. (Blue Cross) that indicated that the provided accepted Medicare's payment as payment in full...

I hope this information is helpful.

LubaM.

I had my treatment at Scripps in Feb. - 10 days of treatment also. I received two bills, one from the clinic (total about $2900) and one from the hospital (total about $13,700). So the grand total is about $16,600.

The hospital has not yet billed my insurance, but the clinic has. I don't have the specific codes they used - they were not listed on the bill or on my insurance EOB.

However, the insurer (Blue Cross Federal PPO), oddly enough, denied some, but not all, of the procedures billed by the clinic. Overall they denied about $1550 worth of charges from the clinic.

When I called Blue Cross to ask why, they said the diagnosis given was not valid for those particular services. But this seems weird because they paid for other services associated with the radiation treatment, with the same diagnosis.

I've very worried about how Blue Cross is going to handle the REALLY big bill from the hospital (almost $14,000).

My questions:

1) Has anyone on this forum had RT who has Blue Cross? If so, did they pay the claim? And what state was the service provided in?

2) Has anyone had RT specifically at Scripps and had a claim denied? If so, was Scripps helpful in resubmitting/appealing? Has anyone had RT at Scripps who is also covered by Blue Cross?

Any info that people can provide would be very helpful, as I am trying not to panic here with these bills for more than $15,000 on my desk.

The good news is that I believe the RT worked. I have my followup visit next week, but it is clear that the disease has not progressed since I did the RT (it was progressing quite rapidly before), and I think my worst nodule has even shrunk.

Also, it is very helpful to see that Medicare has been paying. Hopefully that will be helpful if I need to file an appeal.

Thanks in advance for any help you can provide!

My insurance situation is almost the same as Luba's. Medicare is my primary insurance and Scripps, La Jolla, accepted Medicare payment schedule. Anthem Blue Cross through CalPERS paid the balance which was not very much. I posted the totals last summer. I'll search this site using "Search web site" in the left column and see if I can find it. If so, I'll refer you to it or copy, paste and repost.

Thanks so much to everyone who responded so far. Lori, did you get your RT at Scripps or elsewhere?