eviCore Radiation Therapy Coding Guidelines

eviCore allows limited reimbursement of special physics/dosimetry and planning codes (e.g., 77470, 77370, 77300, 77331, 77336, IMRT/SBRT planning codes) only for specified complex/non‑routine situations (SRS/SBRT, brachytherapy, TBI, multimodality fusion, pacemaker proximity, pediatric anesthesia, etc.) and excludes routine QA, standard 3D‑CRT/IMRT contouring or verification, routine dosimetry, and SBRT when used as a boost or when the episode exceeds five fractions. Key requirements include detailed physician orders and case‑specific justification, custom physicist reports and a separate algorithmic calculation, documented physician review/signature (77331 within 24 hours), and adherence to frequency/packaging limits (e.g., 77470/77370 reported once per course; CT guidance often packaged into simulation codes).

"If not specifically listed on your authorization letter, IGRT, 77370 and 77470 codes require physician review."