Prior Auth Required

77301 - Intensity modulated radiotherapy plan Prior Authorization Required Radiation Oncology No review for non-cancer diagnoses

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceIntensity modulated radiotherapy plan Prior Authorization Required Radiation Oncology No review for non-cancer diagnoses
Procedure / Service Description

Code Description Plan Review Requirement Reviewed For Records Request - operative report if surgical) only for the date of service performed. 77301 Intensity modulated radiotherapy plan Prior Authorization Required Radiation Oncology No review for non-cancer diagnoses. including dose-volume histograms for FOR CANCER DIAGNOSES ONLY: target and critical structure partial tolerance Submit online review with Carelon at

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.