Does 77385 require prior authorization?

No, 77385 does not require prior authorization (high confidence). Code is covered without prior authorization.

`77385`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

With IMRT planning and delivery, the physician must document consideration of other organs at risk (OAR) and adjacent critical structures.
All documentation must be maintained in the patient's medical record, be legible, include appropriate patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
The medical record must include legible signatures and credentials of the physician, non-physician practitioner, dosimetrist, physicist, or radiation therapist responsible for care.
Submitted records must support the selected ICD-10-CM diagnosis code(s) and the submitted CPT/HCPCS code(s) must accurately describe the service rendered at the level of specificity appropriate for the claim year.

Radiation therapy is covered when the patient's medical record documents medical necessity consistent with LCD L39553.
Stereotactic Radiosurgery (SRS) or Stereotactic Body Radiation Therapy (SBRT) is covered for oligometastatic disease when documentation justifies aggressive local therapy to one or more metastatic deposits for total disease clearance or to reduce systemic disease burden with a specifically defined clinical benefit.
SRS or SBRT is covered for palliation or recurrent disease when tumor cannot be treated as effectively or safely by other radiotherapy methods due to proximity to previously irradiated volumes and beneficiary-unique facts are documented.
Radiation therapy for non-cancer diagnoses (e.g., epilepsy, trigeminal/facial nerve conditions, movement disorders, Parkinson's disease, tremor) may be covered only when prior therapies tried and failed are clearly documented with names, durations, and response.
SRS and SBRT require documentation of the patient's overall performance status (e.g., Karnofsky Performance Status or ECOG) and a radiation oncologist's evaluation of clinical and technical aspects with the resulting management decision to support coverage.
IMRT is indicated when highly conformal dose planning is required to spare adjacent normal tissues as a specific clinical benefit for the individual patient.

AMBETTER-CP.MP.69 — Intensity-Modulated Radiotherapy

AMBETTER-CP.MP.251 — Radiation Therapy for Skin Cancer

A59350 — Billing and Coding: Radiation Therapies

L39553 — Radiation Therapies

CARELON-radiation-therapy-excludes-proton-2025-03-23 — Radiation Therapy Excludes Proton

Ask Verity about documentation requirements, denial risks, or coverage in your state.