eviCore Radiation Oncology Coding Manual

The manual specifies appropriate versus excluded uses for radiation oncology CPT codes—for example, 77470 is payable only for truly complex treatment plans (e.g., concurrent cytotoxic chemo, brachytherapy+EBRT, TBI, pediatric anesthesia, reconstruction, hyperthermia, radioimmunotherapy) and not for routine services (contouring, IMRT/SRS/SBRT, PBT, 4DCT gating, BID or multiple sites) and is reported once per episode; 77370 is limited to unusual, board-certified medical-physicist analyses (not routine QA or IMRT/3D QA) and is also once-per-episode, while 77300, 77331 and +77293 have defined indications, bundling/unit limits (e.g., 77300 bundled with many planning codes; SRS/SBRT max 10 units) and certain imaging/simulation guidance (77014) is packaged and not separately reportable. Key requirements: specific physician orders and patient-specific/custom physicist reports (checklists/templates insufficient), physician review/signature timelines (e.g., 77331 signed within 24 hours), documentation of medical necessity for add-ons, and adherence to bundling, episode and unit limits, with exceptions only on a documented case-by-case basis.