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77301 - Intensity Modulated Radiotherapy Plan W/Dose Volume Histograms

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Procedure / ServiceIntensity Modulated Radiotherapy Plan W/Dose Volume Histograms
Procedure / Service Description

Magnetic resonance imaging, breast, without and with contrast material(s), including - 77084 Magnetic resonance (eg, proton) imaging, bone marrow blood supply 77295 3-dimensional radiotherapy plan, including dose-volume histograms 77301 Intensity Modulated Radiotherapy Plan W/Dose Volume Histograms Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote 77316 afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.