Billing and Coding Guidelines for Radiation Oncology ...

Billing and Coding Guidelines for Radiation Oncology Including Intensity Modulated Radiation Therapy (IMRT) LCD Determination ID Number L34652 Guidelines Reasons for Denial Services performed for diagnoses not listed as covered in this policy or for excessive frequency will be denied as not medically necessary. Frequency is considered excessive when services are performed more frequently than generally accepted by peers and the reason for additional services is not justified by documentation. Indications not listed as covered under the Coverage Indications, Limitations, and/or Medical Necessity section will be denied as not medically necessary. When a hospital inpatient is transported to a freestanding facility for therapy, the technical component of the Radiation Oncology services cannot be paid to the freestanding facility.

1. Use CPT code 77306 for a simple teletherapy isodose plan when there are one or two unmodified ports directly at one volume of interest. This code includes basic dosimetry calculations. 2. Use CPT code 77307 for a complex teletherapy isodose plan when multiple treatment areas,

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  Guidelines, Code, Cpt codes

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