Example A — Fiducials + spacer before SBRT
Clinical: Intermediate-risk disease planned for SBRT; three fiducial markers and a hydrogel spacer placed transperineally under ultrasound guidance in one session.
Code(s): 55876 x 1; 55874 x 1 [VERIFY: NCCI pairing/modifiers].
Dx: C61.

Example B — Fiducial markers only
Clinical: Markers placed before IMRT; no spacer.
Code(s): 55876 x 1 (regardless of marker count).
Dx: C61.

Example C — LDR brachytherapy, urologist + radiation oncologist
Clinical: Low-dose-rate seed implant; the urologist places the transperineal needles, the radiation oncologist applies the sources.
Code(s): Urologist: 55875. Radiation oncologist: 77778 (complex interstitial application) and related planning/dosimetry codes.
Dx: C61.

• Planned course: the radiation treatment plan the procedure supports
• Approach and guidance: transperineal/transrectal, imaging modality used
• Devices: number and type of markers; spacer product and volume
• Spacer necessity: rectal-sparing rationale per the payer's coverage criteria
• Brachytherapy roles: which physician performed which portion, in separate notes when separately billed

• Unit errors: bill one unit of 55876 and 55874 per session — multi-unit claims deny.
• Spacer medical necessity: document the rectal-sparing rationale to the payer's criteria before the case.
• Guidance unbundling: do not separately bill included image guidance.
• Role confusion in brachytherapy: keep the urologist's needle placement and the radiation oncologist's source application in separate, clearly attributed documentation.

• 55876 – Placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), prostate, single or multiple — one unit per session
• 55874 – Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance when performed — one unit per session
• 55875 – Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy

• 77778 – Interstitial radiation source application, complex (brachytherapy)
• 77427 – Radiation treatment management, five treatments
• IMRT/SBRT planning and delivery codes — radiation oncology professional/facility billing [VERIFY: current rad-onc code set if detail is needed]

• C61 – Malignant neoplasm of prostate — primary throughout the radiation episode
• Z19.1 / Z19.2 – hormone sensitivity status when concurrent ADT is documented

Tip: the preparatory procedures are performed while the cancer is active — C61, never Z85.46, on these claims.

• Radiation plan linkage: the planned course (EBRT/SBRT/brachytherapy) named in the procedure note
• Device detail: markers placed (number/type), spacer product and volume
• Spacer criteria: the payer's rectal-sparing coverage elements addressed explicitly
• Guidance: imaging modality documented (and not separately billed when included)
• Brachytherapy attribution: the urologist's portion documented independently of the rad-onc portion

• -25 for a same-day significant, separately identifiable E/M with the marker/spacer session
• NCCI-driven modifiers when 55874 and 55876 are reported together [VERIFY: current edits]

• 55876 and 55874: 0-day global. 55875: 90-day global.
• Confirm using your MAC/payer fee schedule.

• Facility charge capture: 55876, 55874, and 55875 for the urology-side sessions; the radiation course itself is captured by the treating radiation department.
• Devices/supplies: markers and spacer product per facility charge policy; confirm device packaging and any device-intensive offsets in ASC/HOPD [VERIFY: SI/packaging].
• Brachytherapy sources: source capture follows the radiation department's charge structure.

• C61 – primary on all radiation-episode claims

Facility tip: align diagnosis coding across the urology procedure claims and the radiation oncology claims for the same episode.

• Procedure note: devices placed, product used, guidance, and plan linkage in the facility record
• Supply log: spacer/marker product documentation matching the charge
• Record alignment: op/procedure note, nursing record, supply log, and charge capture must tell the same story

• Packaging rules vary: device and guidance packaging differ between office, ASC, and HOPD for the marker/spacer sessions.
• Site-of-service variance: 55876/55874 are increasingly office-based — model the economics before shifting settings.
• Payer coverage: hydrogel spacer coverage criteria vary by payer — verify before scheduling [VERIFY: payer policies].