eviCore Radiation Oncology Coding Guidelines

Policy defines when specific radiation oncology codes are payable for patient‑specific complexity (e.g., 77470, 77370, 77300, 77331, +77293, 77301, SRS/SBRT codes) and excludes routine QA or services already bundled into simulation/IMRT/SRS/SBRT/PBT packages or otherwise mutually inclusive codes. Key requirements: patient‑specific written justification and physician orders, custom physicist reports and physician sign‑off (often within 24 hours) as applicable, and adherence to episode/unit limits (most billed once per episode, with specific caps such as a 10‑unit max for 77300 in SRS/SBRT).

"77470 (Special treatment procedure) is payable when the complexity of the radiation therapy treatment plan requires significant additional time and effort not included in another CPT code and is su..."

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