Table A1.
Unit Charge Per Cost Capture
| Description | CPT Code | Professional | Technologic | Global | IMRT | SBRT |
|---|---|---|---|---|---|---|
| Consult level 4 | 99204 | $156.79 | $0.00 | $156.79 | 1 | 1 |
| Simulation | ||||||
| Complex simulation | 77290 | $81.12 | $421.92 | $503.04 | 1 | 1 |
| Complex treatment device | 77334 | $64.38 | $90.47 | $154.85 | 0 | 0 |
| Simple simulation | 77280 | $36.46 | $146.94 | $183.40 | 0 | 5 |
| Treatment planning | ||||||
| Complex treatment planning | 77263 | $167.78 | $0.00 | $167.78 | 1 | 1 |
| Chemotherapy planning | 77014 | $0.00 | $141.77 | $141.77 | 1 | 1 |
| Special treatment procedure | 77470 | $106.09 | $369.09 | $475.18 | 1 | 1 |
| Physics plan | ||||||
| Basic dose calculation | 77300 | $32.37 | $38.06 | $70.43 | 8 | 10 |
| Radiotherapy dose plan for IMRT | 77301 | $417.69 | $1,797.04 | $2,214.73 | 1 | 0 |
| Complex treatment device | 77334 | $64.38 | $90.47 | $154.85 | 1 | 10 |
| MLC treatment device for IMRT | 77338 | $234.11 | $257.38 | $491.49 | 1 | 0 |
| Weekly physics | 77336 | $0.00 | $54.67 | $54.67 | 8 | 1 |
| Three-dimensional planning | 77295 | $238.66 | $883.04 | $1,121.70 | 0 | 1 |
| Special physics consult | 77370 | $0.00 | $113.8 | $113.80 | 0 | 1 |
| Linac robotic plan | G0338 | $0.00 | $1,150.00 | $1,150.00 | 0 | 0 |
| Treatment/management | ||||||
| Five treatments | 77427 | $200.92 | $0.00 | $200.92 | 8 | 0 |
| One SBRT | 77435 | $704.24 | $0.00 | $704.24 | 0 | 1 |
| Treatment delivery, IMRT | 77418 | $0.00 | $511.24 | $511.24 | 44 | 0 |
| Stereo body robotic treatment | ||||||
| 1 | G0339 | $0.00 | $3,761.2 | $3,761.24 | 0 | 0 |
| 2-5 | G0340 | $0.00 | $2,551.3 | $2,551.34 | 0 | 0 |
| Stereo body nonrobotic treatment | 77373 | $0.00 | $1,526.1 | $1,526.05 | 0 | 5 |
| Port films | 77417 | $0.00 | $15.17 | $15.17 | 8 | 0 |
| Total | $29,529.71 | $14,314.87 |
NOTE. 2010 Medicare allowable SBRT codes are for descriptive purposes, because many local Medicare coverage descriptions do not cover prostate cancer; G codes are for descriptive purposes.
Abbreviations: CPT, current procedural terminology; IMRT, intensity-modulated radiation therapy; MLC, multileaf collimator; SBRT, stereotactic body radiation therapy.