Radiation Oncology Clinical Appeal Documentation Requirements

This policy requires specific clinical documentation to support medical necessity for listed radiation oncology CPT codes (simulation, planning, dosimetry, devices, physics, delivery, port imaging, and on‑treatment management) and clarifies billing exclusions/limits—e.g., 77014 (TC) is included in simulation codes (77280–77290, 77295) and not separately reportable, only one imaging technique per encounter is allowed, 77300 and other listed codes cannot be billed together with specific codes, and 77338 is reported once per IMRT plan. Key requirements include a physician’s signed/dated treatment plan and procedure notes, simulation sheets, relevant physics plans/DVH or dose calculations, device documentation, treatment records and weekly On‑Treatment Visit notes, physician justification if allowed units are exceeded or for special procedures (77370, 77399, 77470), and nonspecific check‑off templates are not acceptable.

"Simulation procedures for radiation therapy (CPT 77280 - 77290) for treatment simulation and planning."