E0767, Intrabuccal, systemic delivery of amplitude-modulated, radiofrequencyHCPCS/CPT
Prior Auth Required
At least one active policy explicitly requires prior authorization (high confidence)
EVICORE-HPLAN-CIGNA-3C6BF790C032, Cigna Commercial DME Code List - Effective 03/07/2026
EVICORE-HPLAN-CIGNA-AFCE721BA4F3, Cigna Comprehensive Code List - Effective 03/07/2026
EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025
UHC-POL-electric-tumor-treatment-field-therapy, Electric Tumor Treatment Field Therapy
REGENCE-DME96, Amplitude-Modulated Radiofrequency Electromagnetic Fields (AM RF-EMF) for Cancer Treatment
UMR-POL-UMR-electric-tumor-treatment-field-therapy, Electric Tumor Treatment Field Therapy
SUREST-POL-SUREST-electric-tumor-treatment-field-therapy, Electric Tumor Treatment Field Therapy
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