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TRICARE Policy Manual 6010.60-M, April 1, 2015
Radiology
Chapter 5
Section 2.2
Radiologic Guidance
Issue Date:  January 1, 2007
Authority:  21 CFR 199.4(b)(c), (e)(14), and 32 CFR 199.6(a)(2)
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  
1.0  CPT PROCEDURE CODES
Fluoroscopic Guidance: 77001 - 77003
Computed Tomography Guidance: 77011 - 77014
Magnetic Resonance Guidance: 77021 and 77022
Radiologic Other: 77031 and 77032
2.0  Description
2.1  Use of a fluoroscopy to examine deep structures by means of x-ray; it consists of a fluorescent screen covered with crystals of calcium tungstate on which are projected the shadows of x-rays passing through the body placed between the screen and the source of radiation.
2.2  Fluoroscopic guidance (Current Procedural Terminology (CPT) procedure code 77001) for central venous placement, replacement or removal may be considered for cost-sharing. Fluoroscopic guidance (CPT procedure code 77002) for needle placement (e.g., biopsy, aspiration, injection, localization device) may be considered for cost-sharing. Fluoroscopic guidance (CPT procedure code 77003) and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures may be considered for cost-sharing.
2.3  Computed tomography guidance (CPT procedure code 77011) for stereotactic localization, for guidance of needle placement (CPT procedure code 77012); for guidance and monitoring of parenchymal tissue ablation (CPT procedure code 77013); for guidance for placement of radiation therapy field (CPT procedure code 77014) may be considered for cost-sharing.
2.4  Magnetic resonance guidance for needle placement (CPT procedure code 77021); for guidance and monitoring of parenchymal tissue ablation (CPT procedure code 77022) may be considered for cost-sharing.
2.5  Stereotactic localization guidance for breast biopsy or needle placement (CPT procedure code 77031) may be considered for cost-sharing.
2.6  Mammographic guidance for needle placement for wire localization or for injection, breast may be considered for cost-sharing (CPT procedure code 77032).
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