eviCore Radiation Therapy Coding Guidelines

This eviCore guideline allows limited use of complex dosimetry/planning codes (notably 77470, 77370, 77300, 77331, 77293, 77301 and related SRS/SBRT/IMRT codes) for specified atypical/complex situations (e.g., brachytherapy, TBI, pediatric anesthesia, SIRT, complex electron/photon interactions, image fusion, pacemaker proximity, 4D CT respiratory management) while excluding routine services (e.g., standard 3D‑CRT, routine IMRT/SRS/SBRT planning, QA tasks, contouring, and other specifically listed non‑billable scenarios) and applying limits (many codes report once per course, 77300 unit caps for SBRT/SRS, 77331 per point/angle limits). Key requirements: physician-prescribed requests and robust documentation (custom physics reports addressing the physician’s request, physician review/signature within 24 hours for 77331, specific justification for exceptions) and compliance with bundling/code-pairing prohibitions (e.g., 77300 not reported with listed newer codes; 77293 only for 4D CT respiratory motion).