7 commercial payer policies list G0458. 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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7 policies from 5 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of G0458 |
|---|---|---|
| Cigna Commercial Radiation Oncology Code List - Effective 03/07/2026 | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List - Effective 03/07/2026 | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of G0458 |
|---|---|---|
| Cigna Commercial & Medicare Advantage Radiation Oncology Code List - Effective 01/01/2026 | Jan 1, 2026 | Prior auth required |
| Cigna OBM Radiation Oncology Code List - Effective 01/01/2026 | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of G0458 |
|---|---|---|
| Radiation Therapy Excludes Proton | Not recorded | Covered |
| Policy | Effective | Status of G0458 |
|---|---|---|
| GHI/Emblem Non-City of New York & Medicare Radiation Oncology Code List - Effective 01/01/2026 | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of G0458 |
|---|---|---|
| Health Partners Plans Radiation Therapy Code List - Effective 01/01/2025 | Jan 1, 2025 | Prior auth required |