Provider Alert! Medical Physics Consultations to Become Benefits of Texas Medicaid

Attention: Oncologists

Effective Date: March 1, 2021

Providers 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 12/31/2020

Next 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.