77418
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Treatment planning documentation including contouring that defines the target and identifies/avoids relevant normal structures.
- Providers must reference the most up-to-date CPT manuals and current professional coding guidance prior to claim submission.
Key Coverage Criteria
- Delivery of highly conformal external beam radiation (IMRT) to targets positioned near sensitive normal tissues.
- Use of IMRT when multi-step treatment planning (including contouring to define targets and spare normal structures) is required.
- Patients <18 years of age with a solid tumor.
- Medically inoperable cancer where dose escalation is required.
- Primary malignant or benign bone tumors.
- Re-irradiation when cumulative dose to critical structures would exceed tolerance.
1 Active Policy
AMBETTER-CP.MP.69 — Intensity-Modulated Radiotherapy
Related Codes
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