Glossary

This is the maximum value allowed by Medicare for each specific CPT described service.

American Medical Association: The American Medical Association helps doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues.

American National Standards Institute. Not a government agency. Private institute contracted by the Fed. Government to develop a unification of standards governing the accuracy and privacy of medical transactions.

Anterior Posterior Beam coming in from the front & exiting the back.

Ambulatory patient costs. Same as APG.

APG's are a patient classification system designed to explain the amount and type of resources used in a visit Patients in each APG have similar clinical characteristic and similar resource use and cost.

A device of varying shape and size that is used to hold a radioactive source generally for brachytherapy.

A thermo setting plastic that softens in hot water & solidifies on cooling. It is a device used to immobilize portions of the body during treatment such as the head, breast & abdomen.

Adaptive radiation therapy adapted to the tumor volume per treatment. Methods such as dosimetry and 3D are used in identifying the tumor volume to adapt to radiation therapy.

A beam emitted from a radiation therapy treament machine that can consist of protons, photons, electrons, gamma rays or xrays.

Not cancerous.

Twice daily schedule of fractions of treatment as it is delivered. This is usually the number of fractions or treatment sessions delivered over a specific period of time.

A blocking device used to stabilize the oral cavity during treatment. A bite block is generally used during a stereotactic radiotherapy (SRT) treatment.

A device used to shape the radiation beam.

A tissue equivalent material used to change the surface distribution of a radiation beam to radiate a more precise location.

The use of radioactive sources placed directly into a tumor area to generate local areas of high intensity radiation.

A method of payment for health services in which a health care provider is paid a fixed amount for each person served regardless of the actual services provided.

See CT Scan

A tube that can be introduced into the body.

A measurement of the amount of radiation dose absorbed by the body (1 cGy = 1 rad).

Civilian Health and Medical Program of the Uniformed Service that provides medical coverage for dependents and families of active-duty and retired military personnel.

Treatment with drugs to destroy cancer cells.

Medical billing form used to send charges to insurance companies for payment of services & supplies rendered for medical treatment of a subscribed insured.

This is the specific zone surrounding the gross tumor volume with a physician prescribed margin usually between 5-10mm of tissue at high risk for clinical extension of the tumor beyond the gross tumor volume. This is the region of uncertainty that must be treated as though it contained the primary tumor. The CTV then becomes your best estimate of the clinical extent of the tumor.

The Centers for Medicarei & Medicaidi Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (DHHS) that administers the Medicare program and works in partnership with State governments to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process, and clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments.

This is the amount of money the patient is responsible for after Medicare has made its initial payment. This is the balance of the account. 20% of the allowed charge if the physician is a participating provider & 35% if non-participating.

Federal laws applying to groups of 20 or more, the Consolidated Omnibus Budget Reconciliation Act offers extended coverage for enrollees and family members after group coverage would normally end.

A beam shaping device attached to the head of the treatment machine to form the initial configuration of the treatment beam.

An irregularly shaped beam modifying device used to reconfigure the beam intensity to match irregular tissue contours.

A procedure that utilizes computers to create a 3-dimensional view of a tumor in order to target the tumor as accurately as possible and give it the highest possible dose of radiation while sparing normal tissue as much as possible. It is also known as 3-D or conformational radiation therapy.

The initial encounter with a new patient whose opinion or advice is requested by another physician for further evaluation and/or management of a specific problem. A consultant may initiate diagnostic and/or therapeutic services. A consultant's opinion and services must be documented in the patient's medical record & communicated to the original attending physician.

An amount of money that the member or insured pays directly to a provider at the time services are rendered.

The total scope of benefits under a subscriber's certificate.

Common Procedural Terminology, published by the AMA. Procedure code(s) used to bill medical services provided to the patient.

The process of licensing, accrediting and certifying health care providers prior to allowing them to participate in a provider critical pathway.

Vital internal organs located in the treatment area requiring special shielding or calculation of the delivered volume dose of radiation.

A computer driven tomography scan is an X-ray procedure that uses a computer to produce detailed pictures of the body.

This is the specific zone surrounding the gross tumor volume with a physician prescribed margin usually between 5-10mm of tissue at high risk for clinical extension of the tumor beyond the gross tumor volume. This is the region of uncertainty that must be treated as though it contained the primary tumor. The CTV then becomes your best estimate of the clinical extent of the tumor.

The dollar amount members must pay the provider for covered services before Blues' payments begin.

An electronic probe which is placed on the surface of the body or within a body cavity to measure the actual amount of radiation being delivered to that particular point over or part of a session of therapy.

The dose volume histogram is a graph that shows the percentage of dose across critical structures relating to the dose in the designated treatment areas and is considered part of the 3D Sim & not a billable procedure to Medicare.

Radiation therapy practitioner responsible for production of the patient's treatment plan and any associated quality assurance components.

Clinical dosimetry is a physics calculation used to determine the treatment area, dose rate, number of sessions of treatment, treatment type, and to obtain the precises configuration of the tumor and it's relationship with the critical organ structures. This requires close cooperation between the radiation oncology physician & the radiological physicist to customize the beam parameters to fit the individual patient situation.

The span of time that the brachytherapy source will stay at a specific location along the catheter during treatment.

A very small negatively charged beam that is accelerated by a high voltage electrical beam to either strike a target and produce x-rays or to be released directly from the machine and used as a treatment beam.

The Explanation of Benefits is a report that is sent to the patient, & the participating physician from Medicare & commercial carriers explaining the amount that was charged, the amount that was allowed & the amount that the patient will be responsible for as either a co-payment or meeting of deductible. Non-participating physicians do not get a copy of the EOB, & are not notified of payment to the patient.

A list of medical procedures and associated maximum payments.

Small pieces of metal placed in the body to be used as reference points for radiation treatment.

Post treatment follow-up covers the follow-up evaluation of an established patient. This phase of treatment involves regular patient visits & periodic regular examinations for the physician to evaluate and assess the patient after treatment is completed.

A unit of treatment.

A treatment center that is independent to a hospital.

A device used to treat brain tumors with a high dose of radiation therapy in one day.

The movable arm on treatment machine.

Local cost of living modifier as HCFA realized that there was a difference in the cost of living; the cost of doing business in various areas within the US. It takes into account the cost of personnel, the cost of office space, equipment costs, the cost of malpractice insurance, and other factors. The GPCI's were established nationwide based upon carrier localities with a maximum variation of +/- 5%. These GPCI factors are applied against the national conversion factor to give a local conversion factor that takes into account higher or lower cost of practice in various geographic regions across the country. The GPCIs are a factor in determining the final reimbursement of various medical procedures nationwide.

The unique number assigned to a group health plan to identify members of the plan.

The best clinical estimation of the exact areas of the primary tumor volume.

An agency of the US Dept of HHS that administers Medicare, the federal part of Medicaid and oversees Medicare's health financing; HCFA establishes standards for medical providers that require compliance to meet certification requirements.

The standard claim format used by health plans on which to consider payment to the medical provider.

A set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT). The Healthcare Common Procedure Coding System (HCPCS) was established in 1978 to provide a standardized coding system for describing the specific items and services provided in the delivery of health care. Such coding is necessary for Medicare, Medicaid, and other health insurance programs to ensure that insurance claims are processed in an orderly and consistent manner.

High Dose Rate. Treatment delivery is at higher dose rates. It involves high-intensity radioelements with source radioactivity and energy too great to allow manual handling.

A federal law affecting all participants in the country's health care system, the Health Insurance Portability and Accountability Act of 1996 was developed to improve the portability of coverage for people who lose or change employment, to promote administrative simplification through the use of electronic transactions and to ensure the security and privacy of member information.

Health Maintenance Organization. A state-licensed health maintenance organization that delivers physician and hospital services to members directly or through contracts with affiliated providers. The plan requires members to choose a network provider (a primary care physician) to coordinate their health care.

A prospective payment system (PPS) under Medicare for hospital outpatient services, certain Part B services furnished to hospital inpatients who have no Part A coverage, and partial hospitalization services furnished by community mental health centers. The provisions of this section were further modified by sections 201 and 202 of the Balanced Budget Refinement Act of 1999 (BBRA).

A treatment center aligned in a hospital that treats inpatient and outpatient patients.

Occurs when radiation treatment is delivered more than once in a single day.

A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs.

International Classification of Diseases - 9th Edition. A statistical classification system that arranges diseases & injuries into groups according to established criteria. Diagnosis codes used for billing.

Image Guidance Radiation treatment (stereoscopic x-ray guidance) for localization of target volume for the delivery of radiation therapy.

Any type of restraining device that will conform to the patient's body contour to prevent motion during the treatment delivery phase, such as alpha cradle or aquaplast mask.

Intensity Modulated Radiation Therapy. A method of very precisely delivering a high dose of radiation to a target area while protecting nearby sensitive structures.

The placement of needles through the skin or mucus membranes directly into tissues. Usually serving as the carrier for hyperthermia or radioactive sources.

The placement of a hollow probe or other instrument directly into a body cavity, usually serving as the carrier for hyperthermia or radioactive sources.

To treat with radiation.

The center of the treatment area related to the isodose lines.

A line or series of lines, following the paths of the same dosage distributed from external beams of radiation or surrounding a radioactive source.

Low Dose Rate: Rate of dose delivery is low (under 10cGy per minute)

This is the maximum amount that any provider can bill to a patient for Medicare covered services. This amount is 15% above the allowed charge for a non-participating physician. By law, no provider can bill a Medicare patient for more than 15% over the Assigned Value or Allowed Charge.

A machine used to deliver high-energy x-rays for radiotherapy treatment.

Lymph nodes are part of the immune system found in the neck, behind the ears, in the armpits, and in the groin.

Cancerous tissue.

A temporary applicator surgically implanted in the postoperative breast at the site of removal. Treatment is delivered by an HDR source usually twice a day for 10 treatments.

Government-funded program in the United States that provides medical expense coverage for eligible people under age 65 who are indigent and meet certain other criteria.

Federal program that covers health care for individuals age 65 and over.

A government program of medical care especially for the elderly.

The Medicare component that provides basic hospital insurance to cover the costs of inpatient hospital services, confinement in nursing facilities or other extended care facilities after hospitalization, home care services following hospitalization, and hospice care.

The Medicare component that provides benefits to cover the costs of physicians' professional services, whether the services are provided in a hospital, a physician's office, an extended-care facility, a nursing home, or an insured's home.

The preferred term for coverage that pays many of the costs not covered by the federal program.

The spread of cancer from one part of the body to another.

A code appended to a procedure code that used to indicate extra information about the procedure or to qualify the procedure to be billed specially.

A magnetic resonance imaging scan is a procedure that uses a magnetic field to create detailed pictures of the body.

Moveable blocks withing the head of the collumnator that change the configuration of the beam. Instead of simple linear blocks that only move in and out, the multi-leaf device will allow the physician to create an irregular or custom shaped port without the need for external beam shaping blocks.

All physicians & providers in the healthcare filed will be assigned new numbers to use in Medicare, Medicaid and in every private health insurance plan. Physicians and other health providers will get a NPI which must be used by all plans. The NPI is proposed to be an eight character alphanumeric code.

National Correct Coding Initiative. The Centers for Medicare and Medicaid Services (CMS) developed the Correct Coding Initiative (CCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The CMS developed its coding policies based on coding conventions defined in the American Medical Association's CPT manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices.

An uncharged particle that is nearly equal to a proton and is present in all known nuclei except the hydrogen nucleus.

A stream of uncharged atomic particles.

Treatment beams entering the body at any angle other than vertical (90 degrees/180 degrees) or horizontal (45 degrees/270 degrees).

A physician trained to treat cancer.

Treatment that is intended to relieve symptoms, but not cure disease.

Payments received by participating insurance to a participating physician.

A participating provider accepts assignment of the value for services.

Charges rendered by a physician for patient care & treatment.

Every physician must have a provider identification number that specifies they are a Medicare approved provider physician practicing at a specified office location. All Medicare claims must have this provider number for place of service. This number must appear n Box 33 of the HCFA 1500 claim form.

Entry beam of the treatment beam of the patients body. Multiple beams are combined to form the radiation pattern in the treatment area.

X-ray film taken to verify patient position and treatment field.

A technique where an image is produced by the treatment machine at the time the treatment is being delivered. These are real time images and are equivalent to the static port film images.

Preferred Provider Organization. A group of health care providers working together as a network of providers to provider discounts for services.

Medical practice based on direct contact with the patient without referral from another physician.

The carrier responsible for providing benefits before any other insurer makes payment.

A series of numeric or alphanumeric characters and corresponding descriptions for each medical service.

The portion of a charge for services performed in a hospital that is allocated to the professional services of a physician, as distinct from a technical facility component.

A particle that is identical with the nucleus of the hydrogen atom, that along with neutrons is a constituent of all other atomic nuclei, that carries a positive charge numerically equal to the charge of an electron, and that has a mass of 1.673x10-24 gram

Proton Beam Therapy is a form of external beam radiation therapy which uses protons rather than photons (X-rays).

Person or facility providing services or supplies related to medical care.

Planning Target Volume. This generally is the highest delivered dose area, both on a daily basis as well in total dose. The planned target volume surrounds the gross tumor volume with a physician established margin. The high dose region of the gross tumor volume shapes the target geometry of the planning target volume in three dimensions with rapid fall off of dose outside this target volume.

Radiation Absorbed Dose. The basic unit of measure for expressing absorbed radiant energy per unit mass of material.

Radiation treatment beams.

A radioactive element.

The recommendation by a primary care physician for a member to receive specialized care from a practitioner or facility.

Relative Value Scale: designed at the request of the HCFA to bring radiology - radiation oncology under a tighter required fiscal constraints by Medicare. A national fee schedule tied to a national relative value scale for all specialties. 3 RVU's: Professional, Technical, & Global.

If a physician, supplier, or other person knowingly & willfully improperly bills or collects for service on a repeated basis, or fails to comply with the requirement of an adjustment to billed charges, or the requirement of refund, HCFA may apply sanctions under Section 1842(j)(2) of the Act. There are civil monetary penalties of up to $10,000 of each instance of overcharging, assessments of up to twice the amount overcharged, and/or exclusion from the Medicarei program for up to 5 years.

Small pieces of radioactive material that are inserted into the body for treatment.

A clinical process used to establish the radiation therapy treatment beams to the specified treatment volume that was determined by treatment planning. The process of simulation can only be done by the radiation oncology physician who has a complete knowledge of the location & extent of the patients malignancy. Simulation is used to establish each of the individual treatment beams directed to the area of treatment.

X-ray machine set up to simulate the radiation treatment machine.

This is the measurement of the actual treatment beam in use. This is used to minimize any amount of error for the final dosage. So in order to be absolutely certain of the exact dosage being delivered, it is often necessary to perform special dosimetry measurements of the actual beam in use.

The use of external radiation sources either from a linear accelerator (X-Knife), or a special Cobalt-60 (Gamma Knife) irradiator to deliver many small beams of radiation, all focused on an internal area, such as a brain tumor.

3D external beam radiation therapy using stereotactic guidance to deliver a precise high dose of radiation to a defined area to reduce the damage to normal surrounding tissues.

A treatment technique using a large dose of radiation to a small volume tumor, typically using multiple narrowly focused radiation beams from different angles.

Lateral & medial angled beams that enter the body to treat a specific tumor area minimizing radiation to the surrounding area.

The highest delivered dose area. Area of the body that is intended to receive radiation therapy.

Total Body Irradiation. When radiation is delivered in a manner that it covers the whole body.

Charges rendered by a hospital or freestanding treatment center for providing all of the equipment and personnel that the physician uses to deliver treatment.

The plan of treatment to a patient by the physician. The physician determines the treatment course based on the patient evaluation in consultation, lab tests, x-rays, and report from other treating physicians.

A Department of Defense, regionally managed health-care program for active duty and retired members of the uniformed services and their families that combines military healthcare resources and networks of civilian healthcare professionals. Formerly known as CHAMPUS (the Civilian Health and Medical Program of the United States).

An abnormal lump or mass of tissue.

A standard billing format for submitting hospital claims.

The use of sound waves to generate images of internal body structures.

Unique Physician Identifier Number. Once assigned to a physician, will remain with that physician for the remainder of their professional career. The number is cataloged in the national registry of all physicians in the US & will travel with the physician regardless of their location in the country. This number is different from the Physician's Medicarei Provider Number.

A vacuum formed immobilization device to holds the patient in position during treatment. Will be used during the entire course of treatment, but can be reused later.

A device used for radiation therapy to help reproduce the patient's position and also to immobilizes the patient. The patient is positioned in the device and the air is suctioned out to create a permanent mold.

A treatment beam modifying device acting to change the intensity of the treatment beam in a step like fashion across the width of the treatment beam.