Does 77407 require prior authorization?

No, 77407 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 77407?

Medicare facility rate: $309.96. Non-facility rate: $309.96. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

$309.96

Non-Facility

$309.96

"Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage but does not guarantee coverage of the service requested; refer to the protocol titled Medical Records Documentation Used for Reviews."
For exception/coverage consideration when non-listed condition is requested: comparison of treatment plans for the IMRT and non-IMRT technique (e.g., three-dimensional conformal treatment plan) demonstrating that non-IMRT would increase the probability of clinically meaningful normal tissue toxicity
When the same or an adjacent area has been previously irradiated: prior radiation records and cumulative dose assessment demonstrating that the IMRT dose distribution is sculpted to avoid exceeding cumulative tolerance dose of nearby normal tissue

Applies to individuals 19 years of age and older. (Note: IMRT is covered without further review for individuals younger than 19 years of age.)
IMRT for Definitive Therapy for the primary site of the following conditions: Anus/anal canal cancer
IMRT for Definitive Therapy for the primary site of the following conditions: Breast cancer when either: (a) the left-sided internal mammary nodes are being treated; or (b) accelerated partial breast irradiation of up to 5 fractions
IMRT for Definitive Therapy for the primary site of the following conditions: Central nervous system (CNS) tumors (primary or benign) including the brain, brainstem, and spinal cord
IMRT for Definitive Therapy for the primary site of the following conditions: Cervical cancer
IMRT for Definitive Therapy for the primary site of the following conditions: Endometrial cancer

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

UHC-POL-radiation-therapy-fractionation-image-special-services — Radiation Therapy: Fractionation, Image-Guidance, and Special Services

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

UHC-POL-intensity-modulated-radiation-therapy — Intensity-Modulated Radiation Therapy

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