What parts of a radiation treatment plan must be entered into eviti|Connect for preauthorization?
All treatment CPT Codes must be entered into eviti in order to search for a matching regimen. If your CPT Codes do not match an evidence-based-regimen in our library for that Cancer Type, then you will have the option of building a custom treatment plan. CPT Codes that eviti does NOT review include:
  • initial evaluation & decision to treat
  • simulation
  • imaging
  • immobilization device(s) creation
  • prescription & target delineation
  • treatment planning and management
  • follow-up care
Does radiation simulation need to be preauthorized in eviti|Connect?
No. eviti does not review simulation plans but the insurance company may require preauthorization of this process. Please contact them for further questions.
Does radiation simulation need to be completed prior to submitting the radiation treatment plan in eviti|Connect?
No. eviti can review a radiation treatment plan PRIOR to simulation but recommends submitting the treatment plan AFTER simulation since the plan is finalized. If a treatment plan is submitted in eviti prior to simulation and is revised, it must be re-entered to reflect the actual treatment for proper reimbursement from the insurance company.
What start date should be reflected in a radiation therapy treatment plan?
The start date should reflect the date that the first treatment was administered to the patient.
What cpt codes are impacted with the changes by the American Medical Association?
eviti updated the cpt codes for 1/1/2015. Here is an overview of the changes:
  • Retired Codes: Nine CPT codes traditionally used to report conventional radiation therapy treatment delivery have been retired, and replacement codes have been added.
  • Description Changes: The descriptors and criteria for reporting conventional external beam treatment delivery have changed.
  • Separate IMRT Codes: CPT code 77418 has been deleted and two new codes created to reflect different levels of IMRT complexity.
  • Image Guidance Codes: CPT codes 77421, 76950 and 0197T associated with image guidance and tracking have been retired and a new technology independent IGRT code has been created.

To see which codes are changing, refer to this information sheet.

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