RO Model Episode Summary and Workflow

Start of Episode

Signified by a Treatment Planning code.  The professional M-Code which matches the cancer type should be billed in a claim with a V1 modifier using the same date of service as Treatment Planning Code.

Technical Service Deadline

The patient must be treated with the first RT Technical Service within 28 days of the Start of Episode.  A free-standing clinic will bill the technical M-Code with the matching cancer type with the V1 modifier using the same date of service as the first Technical Code.

End of Episode

Last day of episode is 89 days after the Start of Episode.  On this date of service, a claim should be generated billing the professional and technical M-Code should be billed with the V2 modifier.

Clean Period

The 28 days following the End of Episode date is called the clean period.  Radiation Therapy services furnished during this period should be billed as fee-for-service.