Radiation Oncology Clinical Appeal Documentation Requirements

Covers radiation oncology CPT services for simulation, planning (3D/IMRT/complex/isodose/brachytherapy), IGRT, dosimetry/physics, treatment device fabrication, delivery, port imaging and treatment management when medical necessity is documented; excludes separate reporting of 77014 (CT for planning) which is bundled into simulation codes and of 77300 with specified planning/therapy codes, prohibits reporting a simulation code for an entire IMRT course, limits device billing to the custom device if used with auxiliary boards, and requires justification when billed units exceed allowed amounts. Key requirements: date-of-service–specific documentation including a signed/dated physician treatment plan/prescription and notes (IGRT type/frequency and extra-work justification), appropriate physics plans/reports (DVH for 3D, IMRT/isodose/diode readings as applicable), treatment records/OTVs, device documentation, and physician requests/reports for special physics consults.