Does G0340 require prior authorization?

Yes, G0340 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for G0340?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

Verity

`G0340` — Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment

HCPCS/CPT

Prior Authorization

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

All documentation must be available upon request and the medical record must support the medical necessity and frequency of treatment.
The medical record must document the critical nature of the anatomy or other circumstances necessitating stereotactic treatment, the patient's functional status including Karnofsky Performance Status, the treatment date(s), and the current treatment dose.

Key Coverage Criteria

Stereotactic radiosurgery (SRS) is typically furnished as a single session; when more than one session is required, bill using stereotactic body radiation therapy (SBRT) codes instead of SRS codes.
Coverage on an individual (redetermination/appeal) basis may be considered for lesions that require a high radiation dose per fraction to avoid exposure of surrounding tissues when documentation and supporting literature are provided.
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.

13 Active Policies

L35076 — Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)

J06

A56874 — Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)

J06

A59820 — Billing and Coding: Radiation Therapies

AETNA-CPB-0083 — Stereotactic Radiosurgery

AETNA-CPB-0707 — Headaches: Invasive Procedures

A59350 — Billing and Coding: Radiation Therapies

L39553 — Radiation Therapies

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

UHC-POL-stereotactic-body-radiation-therapy-radiosurgery — Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery

UMR-POL-UMR-stereotactic-body-radiation-therapy-radiosurgery — Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery

AMBETTER-CP.MP.22 — Stereotactic Body Radiation Therapy

SUREST-POL-SUREST-stereotactic-body-radiation-therapy-radiosurgery — Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery

EVICORE-RADIATION-ONCOLOGY-CODING-MANUAL — EviCore Radiation Oncology Coding Manual

`G0340` — Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

13 Active Policies

Related Codes

Have a follow-up question?

G0340 — Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

13 Active Policies

Related Codes

Have a follow-up question?

`G0340` — Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment