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.

However, radiation treatments to the head/neck, prostate and Hodgkin’s disease may require eight or more calculations. E. Teletherapy isodose plan is considered medically necessary for a given course of radiation therapy to a specific volume of interest. The typical course of radiation therapy will require from one to three isodose plans.

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  Therapy, Radiation, Oncology, Radiation oncology, Radiation therapy

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