Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
J6 · Effective Oct 1, 2015
3 active Medicare policies list 63621, and 16 commercial payer policies list it. 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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J6 · Effective Oct 1, 2015
JK · Effective Oct 1, 2015
J6 · Effective Apr 1, 2026
16 policies from 10 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 63621 |
|---|---|---|
| Proton Beam Therapy | Mar 23, 2025 | Covered |
| Radiation Therapy Excludes Proton | Apr 4, 2026 | Covered |
| Radiation Therapy for Non Malignant Disease | Apr 4, 2026 | Covered |
| Policy | Effective | Status of 63621 |
|---|---|---|
| Charged-Particle (Proton) Radiotherapy |
| Oct 1, 2025 |
| Covered |
| Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy for Tumors Outside of Intracranial, Skull Base, or Orbital Sites | Nov 1, 2025 | Covered |
|---|
| Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy of Intracranial, Skull Base, and Orbital Sites | Nov 1, 2025 | Covered |
|---|
| Policy | Effective | Status of 63621 |
|---|---|---|
| Cigna Commercial Radiation Oncology Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of 63621 |
|---|---|---|
| Cigna Commercial & Medicare Advantage Radiation Oncology Code List | Jan 1, 2026 | Prior auth required |
| Cigna OBM Radiation Oncology Code List | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of 63621 |
|---|---|---|
| Stereotactic Radiosurgery | Feb 8, 2023 | Covered |
| Policy | Effective | Status of 63621 |
|---|---|---|
| Stereotactic Body Radiation Therapy | Not recorded | Covered |
| Policy | Effective | Status of 63621 |
|---|---|---|
| Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy | Feb 2, 2026 | Covered |
| Policy | Effective | Status of 63621 |
|---|---|---|
| Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery | Oct 1, 2026 | Covered |
| Policy | Effective | Status of 63621 |
|---|---|---|
| Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery | Oct 1, 2026 | Covered |
| Policy | Effective | Status of 63621 |
|---|---|---|
| Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery | Oct 1, 2026 | Covered |