CPT® Code 77423

Official Description

High energy neutron radiation treatment delivery, 1 or more isocenter(s) with coplanar or non-coplanar geometry with blocking and/or wedge, and/or compensator(s)

Common Language Description

High energy neutron radiation treatment is a specialized therapeutic approach that utilizes neutron beams to target and treat non-operable tumors, particularly those that exhibit resistance to conventional radiation therapies. This treatment is characterized by its delivery to one or more isocenter(s), which are specific points in space where the radiation beams converge, using either coplanar or non-coplanar geometries. The use of coplanar geometry involves aligning the radiation beams in a single plane, while non-coplanar geometry allows for beams to be directed from multiple angles, enhancing the precision of the treatment. The procedure may incorporate various tools such as blocking devices, wedges, and compensators to optimize the radiation delivery and protect surrounding healthy tissues. Neutron beam therapy (NBT) is particularly effective for treating tumors located in sensitive areas such as the salivary glands, head and neck, bones, joints, and soft tissues. The unique properties of neutrons result in a high radiation biological effect, as they remain active at the target site for an extended duration. This prolonged activity increases the likelihood of damaging both strands of the DNA within cancer cells, thereby impairing their ability to survive or repair themselves after treatment. However, it is important to note that NBT also carries a higher risk of irradiating adjacent normal tissues, necessitating careful planning and execution of the treatment. To ensure effective treatment, a detailed planning process is employed, which involves determining the planning target volume, clinical target volume, and gross tumor volume. This planning allows for the identification of one or more isocenters, which are crucial for the accurate delivery of radiation. The treatment plan may utilize multiple coplanar beams to concentrate a higher radiation dose in the overlapping regions or employ non-coplanar beams to minimize exposure to critical structures near the tumor. In cases where additional sparing of critical structures is required, blocks—fabricated articles designed to shield specific areas—wedges—angled sheets that create a radiation intensity gradient—and compensators—bolus materials or filters that adjust the radiation gradient—are utilized to enhance the safety and efficacy of the treatment.

1. Indications

The high energy neutron radiation treatment is indicated for the management of specific types of tumors that are non-operable and resistant to conventional radiation therapy. The following conditions may warrant the use of this treatment:

Non-operable tumors that cannot be surgically removed due to their location or the patient's overall health.
Resistant tumors that have shown limited response to standard radiation therapies.
Target sites including the salivary glands, head and neck regions, bones, joints, and soft tissues where conventional treatments may be less effective.

2. Procedure

The procedure for high energy neutron radiation treatment involves several critical steps to ensure effective delivery of the radiation to the targeted tumor site. Each step is designed to maximize the treatment's efficacy while minimizing damage to surrounding healthy tissues.

Step 1: Identification of Isocenters - The first step involves the identification of one or more isocenters, which are specific points where the neutron beams will converge. This is achieved through careful planning that considers the planning target volume, clinical target volume, and gross tumor volume.
Step 2: Treatment Planning - A detailed treatment plan is developed, which may include the use of multiple coplanar beams aligned in a single plane to deliver a higher radiation dose in the intersecting regions. Alternatively, non-coplanar beams may be utilized to spare critical structures adjacent to the tumor.
Step 3: Application of Blocking, Wedges, and Compensators - To further protect surrounding healthy tissues, various tools such as blocks, wedges, and compensators are employed. Blocks are fabricated articles that shield specific areas of the body, while wedges are angled sheets of metal or lead that create a radiation intensity gradient. Compensators, which can be bolus materials or filters, are used to adjust the radiation gradient and ensure an even distribution of radiation across the treatment area.
Step 4: Delivery of Neutron Beam Therapy - The actual delivery of the neutron beam therapy is performed using specialized equipment that directs the neutron beams according to the pre-established treatment plan. The precision of the delivery is crucial to achieving the desired therapeutic effect while minimizing exposure to adjacent normal tissues.

3. Post-Procedure

After the high energy neutron radiation treatment, patients may require specific post-procedure care to monitor for any potential side effects and ensure proper recovery. It is essential to assess the treatment area for any signs of radiation-induced reactions, which may include skin irritation or changes in tissue integrity. Patients should be advised on follow-up appointments to evaluate the effectiveness of the treatment and to manage any complications that may arise. Additionally, ongoing support and rehabilitation may be necessary, particularly for those who have undergone treatment in sensitive areas such as the head and neck. Regular assessments will help in determining the need for further interventions or adjustments in care.

Short Descr	NEUTRON BEAM TX COMPLEX
Medium Descr	HIGH ENERGY NEUTRON RADJ TX DLVR 1/> ISOCENTER
Long Descr	High energy neutron radiation treatment delivery, 1 or more isocenter(s) with coplanar or non-coplanar geometry with blocking and/or wedge, and/or compensator(s)
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	3 - Technical Component Only Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Procedure or Service, Not Discounted when Multiple
ASC Payment Indicator	Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on MPFS nonfacility PE RVUs.
Type of Service (TOS)	6 - Therapeutic Radiology
Berenson-Eggers TOS (BETOS)	P7A - Oncology - radiation therapy
MUE	1
CCS Clinical Classification	211 - Therapeutic radiology