Medical Physics Consultations to Become Benefits of Texas Medicaid
Attention: OncologistsEffective Date: March 1, 2021Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.Call to action: Effective for dates of service on or after March 1, 2021, medical physics consultations (procedure codes 77336 and 77370) will become benefits of Texas Medicaid. Medical physics consultations will be a benefit of Texas Medicaid when these services are performed by the following:
A physician and the radiation therapy center providers in an office setting
The radiation therapy center and hospital providers in the outpatient hospital setting
Procedure codes 77336 and 77370 may be reimbursed to the ordering physician if consultation is performed with a qualified medical physicist for stereotactic radiosurgery, brachytherapy, or any other method of radiation therapy for which medical necessity is determined.
How this impacts providers: Procedure code 77336 will be limited to once per week of treatment. Procedure code 77370 will be limited to once per course of treatment. A special medical physics consultation may be reimbursed when the input and complex analysis of a qualified medical physicist are beyond that of a continuing medical physics consultation and are necessary to address a patient-specific reason or scenario.
Resource:TMHP Notice dated 12/31/2020Next steps for providers: Providers should share this communication with their staff.
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.