55865
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
23.96
Facility
$1191.08
Non-Facility
$1191.08
Documentation Required
- 0: Fully active; no performance restrictions.
- Ta: Noninvasive localized squamous cell carcinoma
- No documentation requirements are specified in this document excerpt. Refer to the referenced corresponding medical/pharmacy coverage policies for required medical records, test results, and clinical documentation.
- No specific documentation requirements are provided in the provided excerpt.
Key Coverage Criteria
- Treatment of unresectable primary hepatocellular carcinoma (HCC) with Theraspheres (glass yttrium-90 microspheres).
- Electronic brachytherapy for skin lesions
- Conformal external beam radiation
- Particle beam radiation for various tumor indications
- Three-dimensional reference system for radiation treatment
- Brachytherapy is a form of treatment, used for both oncologic and non-oncologic conditions, in which radioactive materials are placed inside the body.
2 Active Policies
CARELON-radiation-therapy-excludes-proton-2025-03-23 — Radiation Therapy Excludes Proton
HUMANA-BRACHYTHERAPY-MA — Brachytherapy - Medicare Advantage
Related Codes
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