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.
Pre-procedural documentation must include a complete initial evaluation with history, focused physical examination, and review of relevant pathology and imaging results.
Treatment plans developed with other providers (e.g., medical oncologist, surgeon, tumor board) should be included when they support that the procedure is reasonable and necessary.
The procedure note must be legible and document mode of radiation delivery, anatomic sites irradiated, radiation dose in Gray, and any necessary pre- and post-procedural assessments, with legible signature, time, and date.

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).
Intraoperative radiation (IORT) is covered when therapeutic radiation is initiated after surgical exposure of the tumor or tumor bed and is completed prior to the patient leaving the operating room.
IORT is covered when surgical resection is reasonable and necessary for treatment of the patient’s malignancy based on available information at the time the decision for surgery is made.
IORT for breast cancer is covered only for patients in whom there is a reasonable expectation at the time of surgery that Accelerated Partial Breast Irradiation (APBI) may be appropriate per NCCN candidacy criteria.
IORT for breast cancer is covered in a woman meeting all of: age >= 50 years; invasive ductal carcinoma; negative margins >= 2 mm; no lymphovascular invasion; estrogen receptor positive; BRCA negative.
IORT for breast cancer is covered in a woman meeting all of: low or intermediate nuclear grade; screen-detected ductal carcinoma in situ (DCIS); tumor size as appropriate per NCCN; negative margins >= 3 mm.

PALMETTO-JJ-L37779, Intraoperative Radiation Therapy

PALMETTO-JM-L37779, Intraoperative RadiationTherapy

EVICORE-HPLAN-CIGNA_MEDICARE-A88AF85430B7, Cigna OBM Radiation Oncology Code List - Effective 01/01/2026

EVICORE-HPLAN-CIGNA_MEDICARE-0348DA3099BA, Cigna Commercial & Medicare Advantage Radiation Oncology Code List - Effective 01/01/2026

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