eviCore Radiation Oncology Coding Guidelines

This eviCore guideline specifies appropriate use and exclusions for radiation oncology codes (notably 77470, 77370, 77300, 77331, +77293, 77301, 77014), stating that 77470/77370 are limited to uncommon high‑complexity or unusual physics/planning work (not routine services), 77300/77331 are limited to discrete verification calculations/measurements (and are excluded/bundled with many planning/delivery codes), +77293 is for 4D respiratory motion simulation only (not DIBH or routine registrations), and CT/advanced imaging in simulation codes are packaged and may not be billed separately. Key requirements: robust patient‑specific documentation (physician requests, custom physicist reports, separate algorithmic calculations, physician review/sign‑off within 24 hours), many codes are limited to once‑per‑episode use, and check‑off sheets/templates are insufficient—exceptions require detailed supporting records.

"77470: Billed when the complexity of the radiation therapy treatment plan is such that significant additional time and effort are required to deliver treatment effectively and when such time and ef..."