Does C9726 require prior authorization?

Yes, C9726 requires prior authorization (high confidence). Code explicitly requires prior authorization.

`C9726`, Placement and removal (if performed) of applicator into breast for

HCPCS/CPT

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

ICD-10-CM diagnosis codes supporting medical necessity must be submitted with each claim; include any additional medical records or forms required by LCD L37779.
Clinical treatment planning: "Documentation is required to report clinical treatment planning. Necessary documentation includes the diagnosis, treatment site, treatment intent, treatment dose, treatment technique and any special circumstances unique to the individual."
General: "The radiation oncologist is responsible for documentation of IGRT directives, supervision, and review of all images."
Simulation: "Appropriate documentation for simulation services includes: the treatment site, type of images, if a clinical simulation is performed, and any immobilization devices that are constructed. The documentation should be signed and dated by the physician."

Intraoperative radiation therapy (IORT) claims are covered when submitted with ICD-10-CM diagnosis codes that support medical necessity per applicable clinical criteria (see LCD L37779).
Clinical treatment planning (CPT® 77261, 77262, 77263): One unit of CPT® 77261, 77262, or 77263 is necessary for an episode of care (clinical treatment planning is performed after the initial consultation and before simulation).
Simulation (CPT® 77280, 77285, 77290): For non-IMRT plans, one unit of CPT® 77280, 77285, or 77290 is allowed per phase of treatment; verification simulation reported with one unit of CPT® 77280. (+77293 respiratory motion management simulation is allowed when treatment area moves with continuous respiration and requires acquisition of multiple data sets.)
Respiratory motion management simulation (CPT® +77293): Performed when the treatment area moves with continuous respiration; +77293 is an add-on code, allowed once per episode of care and only on same date of service as primary procedure (e.g., with 77295, 77301).
Teletherapy isodose planning (CPT® 77306, 77307): One unit allowed for each treatment site approved when a teletherapy isodose plan has been authorized.
3-D conformal planning (CPT® 77295): One unit allowed per episode of care when 3-D conformal has been authorized.

PALMETTO-JJ-L37779, Intraoperative Radiation Therapy

PALMETTO-JM-L37779, Intraoperative RadiationTherapy

EVICORE-HPLAN-CIGNA-1815296EE67F, Cigna Comprehensive Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA-08C913805997, Cigna Commercial Radiation Oncology Code List - Effective 03/07/2026

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