eviCore Radiation Therapy Coding Guidelines

eviCore’s guidelines specify which radiation planning, physics, dosimetry, simulation and delivery CPT codes are medically necessary versus bundled or excluded — approving special/planning/physics codes for unusual or complex scenarios (e.g., brachytherapy, TBI, pediatric anesthesia, fusion of multiple modalities, pacemaker proximity, respiratory motion, and SRS/FSRT/SBRT only when delivered as a complete course) while excluding routine uses (standard breast/prostate planning, routine QA, IMRT fusion is included in 77301, and many services are bundled and not separately billable). Key requirements: patient‑specific physician orders, detailed custom physicist reports and signed physician review, documentation of medical necessity and course dates, adherence to frequency/unit limits (e.g., 77470 once per course, 77336 once per 5‑fraction period, SBRT/FSRT ≤5 fractions, billing limits on 77300/77331), and submission of supporting evidence for any exceptions.