## **What is HCPCS code G6002?**
HCPCS code G6002, maintained by CMS and falls under Radiation Therapy Services, is used to report Stereoscopic X-ray guidance for localization of the target volume for the delivery of radiation therapy. It is an Image-Guided Radiation Therapy (IGRT) code, a specific methodology used by radiation oncologists to ensure the radiation beam is precisely aligned with the tumor (target volume) before each treatment fraction.
The purpose of this service is to increase treatment accuracy by using two X-ray images (stereoscopic) to create a 3D-like localization of the target, allowing the radiation therapist to make real-time, precise positional corrections to the patient or treatment couch. This technique is particularly beneficial in radiation treatment management, specifically complex treatment scenarios such as Stereotactic Body Radiation Therapy, Intensity-Modulated Radiation Therapy (IMRT), and Three-Dimensional Conformal Radiation Therapy (3DCRT).
## **HCPCS code G6002 documentation requirements**
To support the medical necessity and billing for G6002 in radiation oncology coding, documentation in the patient's medical record must include:
- **Medical necessity**: Clear support for why image guidance was medically necessary for the patient's specific treatment course (e.g., target location/motion, use of fiducial markers, type of treatment being delivered).
- **Physician involvement/supervision**: The technical component requires the direct supervision of a physician (on-site and immediately available).
- **Image review and approval**: Appropriate documentation should show that the images and any necessary couch shifts were reviewed and approved by the radiation oncologist before the treatment fraction proceeded. This can be a note in the chart or a physician's electronic signature on the shifts/images. A unique daily note is typically not required, but the review/approval must be documented.
- **Date of service and treatment details**: The date the service was performed, and which fraction of treatment it was associated with.
These documentation elements are vital for substantiating the medical necessity of the procedure and ensuring compliance with billing and coding standards.
## **G6002 billing requirements**
When billing for HCPCS code G6002, providers should adhere to the following guidelines:
- **Professional component**: For freestanding centers, report G6002 under the Medicare Physician Fee Schedule (MPFS) without modifiers. In hospital settings, use the -26 modifier to indicate the professional component.
- **Technical component**: In hospital settings, the technical component of image guidance is bundled into treatment delivery codes and should not be reported separately.
- **Bundling**: The technical component of IGRT, including G6002, is often bundled into Intensity-Modulated Radiation Therapy (IMRT) delivery codes (e.g., CPT 77385 or 77386, or G-codes G6015, G6016) or Stereotactic Body Radiation Therapy (SBRT) treatment delivery in the hospital outpatient setting by CMS. However, the professional component (G6002-26) may still be reported separately.
- **Conventional treatment**: When used with conventional radiation treatment delivery, both the professional and technical components may generally be reported.
- **Payer differences**: Payer rules for IGRT can vary significantly. It is critical to verify the specific billing requirements with each payer, as some may prefer CPT codes like 77387 or 77014 over the G-codes.
- **Documentation**: Ensure all necessary documentation is submitted to support the claim, including imaging reports and physician notes.
Adhering to these billing practices ensures proper reimbursement and compliance with payer policies.
## **Other relevant codes**
- **CPT 77387**: Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking, when performed.
- **CPT 77014**: Computed tomography guidance for placement of radiation therapy fields.
- **HCPCS G6001**: Ultrasonic guidance for placement of radiation therapy fields.
- **HCPCS G6002**: Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy
- **HCPCS G6017**: Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy.
These codes pertain to various image-guided radiation therapy (IGRT) techniques and may be used in conjunction with G6002, depending on the specific imaging method employed.
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