Radiation Oncology Clinical Appeal Documentation Requirements

Covers a wide range of radiation oncology services (CT simulation, IGRT, physician treatment plans, simulation/3D/IMRT/brachytherapy planning, dose calculations, physics services, devices, treatment delivery, port imaging and management) when medically necessary and documented, but excludes separate reporting of CT acquisition 77014 (bundled into simulation codes 77280–77290, 77295), disallows separate reporting of 77300 with specified codes (0394T, 0395T, 77306–77307, 77316–77318, 77321, 77767–77772, 77778), and restricts reporting of simulation for an entire course if IMRT is used. Key requirements: specific, date‑of‑service documentation is required (physician‑signed treatment plan/prescription, simulation sheet/procedure note, physics/3D/IMRT plans and dose verifications, device/diode orders and readings, treatment records, weekly physics/chart checks and OTV notes), and clinical justification must be provided whenever allowed units are exceeded or services fall outside bundled codes.