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CODING GUIDELINES - eviCore

Radiation Therapy Effective January 1, 2018 CODING GUIDELINES for medical necessity review of radiation therapy services. 2018 eviCore healthcare. All rights reserved. CODING GUIDELINES Page 2 of 12 Please note the following: CPT Copyright 2017 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Page 3 of 12 Please note the following: All information provided by the NCCN is Referenced with permission from the NCCN Clinical Practice GUIDELINES in Oncology (NCCN GuidelinesTM) 2018 National Comprehensive Cancer Network. The NCCN GuidelinesTM and illustrations herein may not be reproduced in any form for any purpose without the express written permission of the NCCN. To view the most recent and complete version of the NCCN GUIDELINES , go online to CCI or NCCI (National Correct CODING Initiative) is an initiative taken by CMS.

7. Pediatric patient requiring daily anesthesia and daily physician supervision 8. Hyperthermia 9. Cases requiring reconstruction of previous treatment plans; or combined dose effects of brachytherapy and external beam treatment 10. Selective Internal Radiation Therapy (SIRT) 11. Radioimmunotherapy when combined with external beam treatment 12.

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  Patients, Pediatric, Anesthesia, Pediatric patients

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