63620
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
15.21
Facility
$1113.25
Non-Facility
$1113.25
Documentation Required
- All documentation must be available upon request and the medical record must support the medical necessity and frequency of treatment.
- The medical record must document the critical nature of the anatomy or other circumstances necessitating stereotactic treatment, the patient's functional status including Karnofsky Performance Status, the treatment date(s), and the current treatment dose.
- When requesting individual consideration at redetermination, providers must submit all relevant medical records and supporting literature, including at minimum two Phase II studies or one Phase III study for Contractor Medical Director review.
- If billing more than allowed units of CPT 77334 (total units >6 or units > isocenters+3), document factors such as multiple isocenters, target volume irregularity, proximity to critical structures, or other reasons justifying additional dosimetry/treatment device units.
Key Coverage Criteria
- Stereotactic radiosurgery (SRS) is typically furnished as a single session; when more than one session is required, bill using stereotactic body radiation therapy (SBRT) codes instead of SRS codes.
- Coverage on an individual (redetermination/appeal) basis may be considered for lesions that require a high radiation dose per fraction to avoid exposure of surrounding tissues when documentation and supporting literature are provided.
- Stereotactic Radiosurgery (SRS) is indicated for primary central nervous system malignancies as a boost or salvage therapy.
- SRS is indicated for primary and secondary tumors involving brain or spine parenchyma, meninges/dura, or immediately adjacent bony structures.
- SRS is indicated for benign intracranial and spinal tumors (e.g., meningioma, acoustic neuroma, schwannoma, pituitary adenoma, pineocytoma, craniopharyngioma, glomus tumor, hemangioblastoma).
- SRS is indicated for cranial vascular lesions such as arteriovenous malformations (AVM), cavernous malformations, and hemangiomas.
12 Active Policies
L35076 — Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
J06
A56874 — Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
J06
CARELON-radiation-therapy-excludes-proton-2025-03-23 — Radiation Therapy Excludes Proton
UHC-POL-stereotactic-body-radiation-therapy-radiosurgery — Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery
Related Codes
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