Billing and Coding: Proton Beam Radiotherapy

Coverage for proton beam radiotherapy follows Local Coverage Determination L33937 and is allowed only when the service meets the LCD's reasonable and necessary requirements. Claims must be supported by complete, legible medical records (including patient identifiers and provider signature) that justify the selected ICD-10-CM and CPT/HCPCS codes; non-covered services must be billed with the appropriate modifier. Compliance may be monitored through post-payment data analysis and medical review audits.

"Coverage for proton beam radiotherapy is determined by Local Coverage Determination L33937 and is allowed only when the service meets the LCD's reasonable and necessary requirements."

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