Intraoperative Radiation Therapy
JJ · Effective Sep 24, 2018
3 active Medicare policies list 77425, and 9 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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JJ · Effective Sep 24, 2018
JM · Effective Sep 24, 2018
National · Effective Oct 1, 2025
9 policies from 6 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 77425 |
|---|---|---|
| Aetna Radiation Oncology Code List | Jan 1, 2026 | Prior auth required |
| Intraoperative Radiation Therapy (IORT) | Sep 22, 2023 | Covered |
| Policy | Effective | Status of 77425 |
|---|---|---|
| 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 77425 |
|---|---|---|
| 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 77425 |
|---|---|---|
| Radiation Therapy (excludes Proton) | Apr 4, 2026 | Covered |
| Policy | Effective | Status of 77425 |
|---|---|---|
| GHI/Emblem Non-City of New York & Medicare Radiation Oncology Code List | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of 77425 |
|---|---|---|
| Health Partners Plans Radiation Therapy Code List | Jan 1, 2025 | Prior auth required |