Does 77438 require prior authorization?

No, 77438 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 77438?

Medicare facility rate: $110.56. Non-facility rate: $110.56. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

$110.56

Non-Facility

$110.56

Documentation: Providers may be required to submit clinical documentation in support of a request for services.

Indication: SRS is appropriate to treat small-volume intracranial AVMs with volume ≤ 10 cm or diameter ≤ 3 cm.
Indication: RT is appropriate for early-stage Dupuytren’s contracture when Tubiana stage 0-1 qualifies for definitive treatment.
Indication: Orbital radiotherapy for Graves’ ophthalmopathy in recent-onset active disease.
Indication: SRS for trigeminal neuralgia is appropriate when the patient is not a surgical candidate or declines surgery.
Indication: Radiotherapy for jugular paraganglioma is appropriate when the patient is not a good surgical candidate or refuses surgery.
Indication: Radiation therapy is appropriate for keloid scars when either of the specified conditions is met.

CARELON-radiation-therapy-for-non-malignant-disease-2026-04-04, Radiation Therapy for Non Malignant Disease

CARELON-radiation-therapy-excludes-proton-2026-04-04, Radiation Therapy Excludes Proton

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