Radiation Oncology Clinical Appeal Documentation Requirements

Covers medically necessary radiation oncology CPT services for planning, simulation, dosimetry, devices, physics, delivery (including SRS/SBRT) and radionuclide therapy, but excludes separate reporting of specified bundled codes (e.g., CT 77014 is included in 77280‑77290/77295; 77300 and 77370 are not separately reportable with listed codes) and limits to one imaging technique per encounter. For appeals/payment review the policy requires date‑specific documentation — signed physician treatment plans/prescriptions, procedure and physics plans/reports (e.g., DVHs for 3D/IMRT), medical necessity justification and support for any exceeded units/devices or extra radiopharmaceutical doses, full reports for unlisted/special services, and adherence to stereotactic fraction/course limits (multifraction SRS 2–5 fractions; SBRT ≤5 fractions).

"IMRT Treatment Device (77338) — IMRT-specific treatment device documentation for IMRT delivery."