Does G0458 require prior authorization?

Yes, G0458 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for G0458?

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

HCPCS/CPT

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation may be required to support a service request and must reflect the clinical situation at the time and document the ordering provider’s clinical intent.

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

EVICORE-HPLAN-EMBLEM_GHI-8F6385AD7D76, GHI/Emblem Non-City of New York & Medicare Radiation Oncology Code List - Effective 01/01/2026

EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-0414D494E567, Health Partners Plans Radiation Therapy Code List - Effective 01/01/2025

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