2 commercial payer policies list G6004. 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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2 policies from 2 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of G6004 |
|---|---|---|
| Radiation Therapy Excludes Proton | Apr 4, 2026 | Covered |
| Policy | Effective | Status of G6004 |
|---|---|---|
| Health Partners Plans Radiation Therapy Code List | Jan 1, 2025 | Prior auth required |