8 commercial payer policies list 55874. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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8 policies from 4 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 55874 |
|---|---|---|
| Brachytherapy | Mar 2, 2026 | Covered |
| Intensity Modulated Radiation Therapy | Mar 2, 2026 | Covered |
| Proton Beam, Neutron Beam and Carbon Ion Radiation Therapy | Mar 2, 2026 | Covered with conditions |
| Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy | Feb 2, 2026 | Covered |
| Policy | Effective | Status of 55874 |
|---|---|---|
| Perirectal Hydrogel Spacer for Prostate Radiotherapy |
|---|
| Apr 4, 2026 |
| Covered |
| Radiation Therapy Excludes Proton | Apr 4, 2026 | Covered |
|---|
| Policy | Effective | Status of 55874 |
|---|---|---|
| Prostate Surgeries and Interventions | Jun 1, 2026 | Covered |
| Policy | Effective | Status of 55874 |
|---|---|---|
| Prostate Services and Procedures and Impotence Treatment | Not recorded | Covered |