ROCC Exam Format | Course Contents | Outline | Syllabus | Objectives

ROCC Exam Syllabus & Study Guide

Before you start practicing with our exam simulator, it is essential to understand the official ROCC exam objectives. This course outline serves as your roadmap.

The information below reflects the 2026 syllabus defined by AMAC.

Below are complete topics detail with latest syllabus and course outline, that will help you good knowledge about exam objectives and topics that you have to prepare. These contents are covered in questions and answers pool of exam.

1. Radiation Oncology Modalities & Procedure Coding Clinical Treatment Planning - CPT 77261–77263 (simple, intermediate, complex) - Documentation requirements for level selection - When planning is reported vs. included in other services Simulation - CPT 77280–77290 (simple to complex) - Special simulation (e.g., 77293 for respiratory motion management) - Simulation vs. image guidance distinctions Isodose Planning & Dosimetry - Teletherapy isodose plans (77306–77307) - 3D radiotherapy plan (77295) - IMRT plan (77301) - Brachytherapy isodose plans (77316–77318) - Basic dosimetry calculation (77300) - Special dosimetry (77331) Treatment Devices - Design and construction of treatment devices (77332–77334) - Multi-leaf collimator (MLC) devices and compensators Image Guidance & Localization - CPT 77014 (CT guidance) - IGRT codes and when they are separately reportable - Relationship to treatment delivery Treatment Delivery - Conventional external beam - IMRT / VMAT delivery - Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) - Proton therapy (when applicable) - 2026 delivery code updates (levels based on complexity, motion management, multiple isocenters, etc.) Brachytherapy - HDR and LDR interstitial, intracavitary, and surface applications - Electronic brachytherapy - Associated planning, loading, and delivery codes - Bundling rules with other services Special Procedures & Physics - Special physics consultation (77370) - Special treatment procedure (77470) - Hyperthermia, total body irradiation, and other specialized techniques 2. Evaluation and Management (E/M) Coding Questions focus on proper level selection and documentation in the radiation oncology setting. New & Established Patient Visits - Office/outpatient E/M codes - Time-based vs. medical decision-making (MDM) guidelines Consultations - Appropriate use of consultation codes vs. new patient codes - Documentation of request and report Subsequent Care & Treatment Management - Weekly treatment management (77427) - Special treatment management codes - Coordination of care documentation Key Rules - Same-day E/M with procedures (modifier 25 requirements) - Shared/split visits - Teaching physician rules (when applicable) 3. ICD-10-CM Diagnosis Coding Accuracy in diagnosis coding is heavily tested, especially site specificity and sequencing. Malignancy Coding - Primary site selection - Secondary (metastatic) sites - Laterality and specific anatomic sites relevant to radiation fields History & Follow-up - Personal history of malignancy codes - Aftercare and follow-up codes - When to use active treatment vs. history codes Related Conditions - Symptoms, complications, and treatment-related conditions - Coding for benign conditions treated with radiation (e.g., keloids, heterotopic ossification) 4. Compliance, Billing & Regulatory Requirements These questions test understanding of rules that affect claim payment and audit risk. Medicare Policies - National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) specific to radiation oncology - Medical necessity documentation - Frequency limitations and utilization guidelines Bundling & Edits - National Correct Coding Initiative (NCCI) edits - Procedure-to-procedure and medically unlikely edits - Proper use of modifiers (59, X{EPSU}, 26, TC, etc.) Professional vs. Technical Component - Global, professional-only, and technical-only billing - Facility vs. freestanding setting differences Documentation & Audit Readiness - Required elements to support coded services - Physician supervision requirements - Advanced Beneficiary Notice (ABN) usage - Common audit targets in radiation oncology 5. Supporting Knowledge Areas These topics appear throughout the exam as supporting knowledge. Code Sets & Resources - Current CPT, HCPCS Level II, and ICD-10-CM code structure and guidelines - Use of the ASTRO/ACR Guide to Radiation Oncology Coding Terminology & Process of Care - Radiation oncology workflow (consultation → planning → simulation → treatment → follow-up) - Common vocabulary (isocenter, fractionation, GTV/CTV/PTV, etc.) Practice Variation - Understanding that methodologies of radiation delivery may vary by practice, facility, and equipment