Radiotherapy

Procedure coding

Procedure coding for radiotherapy (or radiation therapy) is well-established in European countries. The preparation and delivery of the radiotherapy are coded separately. Typically, the codes differ depending on the mode of delivery (external or internal) and type of radiotherapy (three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, stereotactic radiotherapy, etc.). For example, in Sweden, intensity-modulated radiotherapy is specifically coded via a KVÅ code DV070 “Radiation therapy, IMRT (intensity modulated radiotherapy)”, whereas in England, a nonspecific supplementary code Y91.1 “Megavoltage treatment for complex radiotherapy” can be used in addition to codes for radiotherapy delivery to indicate the method. 

In some countries, coding for radiotherapy preparation or delivery might be complex, with multiple codes depending on the number of imaging techniques used for the preparation of radiotherapy or radiotherapy regimens. For example, in England, there are several OPCS codes for different modes of brachytherapy, including intracavitary (code X65.2), interstitial (code X65.2), and intraluminal brachytherapy (code X65.6). Supplementary codes are used to specify the high-dose-rate or low-dose-rate brachytherapy and the type of radioactive material (removable or non-removable). 

The use of certain types of radiotherapy can be limited by clinical indications. For example, in France, the use of CCAM code ZZNL050 “External Intensity-modulated radiation session using linear accelerator, without the target position control” for intensity-modulated radiation therapy is limited to head and neck tumors when protection of the salivary glands is necessary, tumors of the spine and tumors of the base of the skull and the vault, excluding high-grade glioma.

Policy considerations

Due to its high medical and social importance, radiotherapy can be subject to specific policies from payers or national decision-makers in the countries where such frameworks exist. 

For example, in England, radiotherapy is commissioned by the national payer, NHS England, in terms of the National Program of Care “Cancer”. Clinical Reference Group “B01 Radiotherapy” of the National Program of Care “Cancer” is responsible for the development of the policy documents, including a service specification document “Radiotherapy (All Ages)” (2013) and “Stereotactic Radiosurgery and Stereotactic Radiotherapy (Intracranial) (All Ages)” (2019).

In some countries, national decision-makers can restrict reimbursement for certain types of radiotherapy to limited clinical indications or age groups. For example, in Germany, the Federal Joint Committee (G-BA) in 2022 decided that stereotactic radiosurgery for treating patients with operable brain metastases would be covered by statutory health insurance, as the result of the G-BA's evaluation of the method according to § 135 (1) Sentence 1 SGB V. 
 

Future challenges 

Radiotherapy in cancer has established reimbursement and funding in many European countries. However, novel regimens and approaches to radiotherapy preparation and delivery might require adjustment of payment mechanisms to fully leverage their unique technology or cost profile.