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When SBRT is performed with IMRT planning, initial simulations (CPT 77290) are not billable because they cannot be billed in conjunction with IMRT treatment plans. However, verification simple simulations are allowed since SBRT treatments do not utilize IMRT fractions. The only time verification simple simulations are not billable is when they ar4e associated with active IMRT treatment delivery.

To support reimbursement, it’s essential that:
• The new CT dataset demonstrates a meaningful change in tumor volume or anatomy.
• There is clear medical necessity documentation from the radiation oncologist explaining the rationale for the updated plan.

This ensures accurate and compliant billing aligned with payer expectations and clinical appropriateness.